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Hamatani T, Atsuta N, Sano F, Nakamura R, Hayashi Y, Sobue G. ALSFRS-R decline rate prior to baseline is not useful for stratifying subsequent progression of functional decline. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:388-399. [PMID: 38323575 DOI: 10.1080/21678421.2024.2309989] [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: 09/07/2023] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE One of the difficulties in developing a novel drug for patients with amyotrophic lateral sclerosis (ALS) is the significant variation in the clinical course. To control this variation, a 12-week run-in period is used in some clinical trials. Based on the Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R) change during the run-in period, only moderate progressors are selected in some clinical trials. Some reports showed that the ALSFRS-R progression rate was associated with survival. However, it is unclear whether the ALSFRS-R change in the run-in period is a useful prognostic factor of the ALSFRS-R change from baseline. In addition, we explore the inclusion criteria that could control the variability in ALS-function progression without setting a run-in period. METHODS We utilized the Japanese and US ALS registry databases (JaCALS and PRO-ACT). Patients were classified into three populations (rapid, moderate, and slow progressors) based on the ALSFRS-R change prior to baseline. We also classified patients into three prognostic populations based on the ALSFRS-R change from baseline. We confirmed whether each of the three populations were matched with their respective three prognostic populations. RESULTS Our data showed that the three groups classified by the ALSFRS-R change during the 12 weeks prior to baseline or by the rate of progression from onset to baseline did not accord with the three prognostic groups. CONCLUSIONS Our results showed that the ALSFRS-R change in the run-in period or from onset to baseline is not useful for stratifying subsequent progression of functional decline in clinical trials.
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Affiliation(s)
- Tatsuto Hamatani
- Drug Development Division, Sumitomo Pharma Co., Ltd, Tokyo, Japan
- Clinical Research, Sumitomo Pharma America, Inc, USA
| | - Naoki Atsuta
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Fumiya Sano
- Drug Development Division, Sumitomo Pharma Co., Ltd, Tokyo, Japan
| | - Ryoichi Nakamura
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yukikazu Hayashi
- Department of Business Development, A2 Healthcare Corporation, Tokyo, Japan, and
| | - Gen Sobue
- Aichi Medical University School of Medicine, Nagakute, Japan
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2
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Nakamura R, Tohnai G, Nakatochi M, Atsuta N, Watanabe H, Ito D, Katsuno M, Hirakawa A, Izumi Y, Morita M, Hirayama T, Kano O, Kanai K, Hattori N, Taniguchi A, Suzuki N, Aoki M, Iwata I, Yabe I, Shibuya K, Kuwabara S, Oda M, Hashimoto R, Aiba I, Ishihara T, Onodera O, Yamashita T, Abe K, Mizoguchi K, Shimizu T, Ikeda Y, Yokota T, Hasegawa K, Tanaka F, Nakashima K, Kaji R, Niwa JI, Doyu M, Terao C, Ikegawa S, Fujimori K, Nakamura S, Ozawa F, Morimoto S, Onodera K, Ito T, Okada Y, Okano H, Sobue G. Genetic factors affecting survival in Japanese patients with sporadic amyotrophic lateral sclerosis: a genome-wide association study and verification in iPSC-derived motor neurons from patients. J Neurol Neurosurg Psychiatry 2023; 94:816-824. [PMID: 37142397 DOI: 10.1136/jnnp-2022-330851] [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: 11/28/2022] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Several genetic factors are associated with the pathogenesis of sporadic amyotrophic lateral sclerosis (ALS) and its phenotypes, such as disease progression. Here, in this study, we aimed to identify the genes that affect the survival of patients with sporadic ALS. METHODS We enrolled 1076 Japanese patients with sporadic ALS with imputed genotype data of 7 908 526 variants. We used Cox proportional hazards regression analysis with an additive model adjusted for sex, age at onset and the first two principal components calculated from genotyped data to conduct a genome-wide association study. We further analysed messenger RNA (mRNA) and phenotype expression in motor neurons derived from induced pluripotent stem cells (iPSC-MNs) of patients with ALS. RESULTS Three novel loci were significantly associated with the survival of patients with sporadic ALS-FGF1 at 5q31.3 (rs11738209, HR=2.36 (95% CI, 1.77 to 3.15), p=4.85×10-9), THSD7A at 7p21.3 (rs2354952, 1.38 (95% CI, 1.24 to 1.55), p=1.61×10-8) and LRP1 at 12q13.3 (rs60565245, 2.18 (95% CI, 1.66 to 2.86), p=2.35×10-8). FGF1 and THSD7A variants were associated with decreased mRNA expression of each gene in iPSC-MNs and reduced in vitro survival of iPSC-MNs obtained from patients with ALS. The iPSC-MN in vitro survival was reduced when the expression of FGF1 and THSD7A was partially disrupted. The rs60565245 was not associated with LRP1 mRNA expression. CONCLUSIONS We identified three loci associated with the survival of patients with sporadic ALS, decreased mRNA expression of FGF1 and THSD7A and the viability of iPSC-MNs from patients. The iPSC-MN model reflects the association between patient prognosis and genotype and can contribute to target screening and validation for therapeutic intervention.
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Affiliation(s)
- Ryoichi Nakamura
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Genki Tohnai
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Division of ALS Research, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Masahiro Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Naoki Atsuta
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Fujita Health University, Toyoake, Aichi, Japan
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Daisuke Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Mitsuya Morita
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takehisa Hirayama
- Department of Neurology, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Neurology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Naoki Suzuki
- Department of Neurology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Ikuko Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaya Oda
- Department of Neurology, Vihara Hananosato Hospital, Miyoshi, Hiroshima, Japan
| | - Rina Hashimoto
- Department of Neurology, National Hospital Organization Higashinagoya National Hospital, Nagoya, Aichi, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization Higashinagoya National Hospital, Nagoya, Aichi, Japan
| | - Tomohiko Ishihara
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Toru Yamashita
- Department of Neurology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Koji Abe
- Department of Neurology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kouichi Mizoguchi
- Department of Neurology, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
| | - Toshio Shimizu
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kazuko Hasegawa
- Division of Neurology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Kenji Nakashima
- Department of Neurology, National Hospital Organization, Matsue Medical Center, Matsue, Shimane, Japan
| | - Ryuji Kaji
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Jun-Ichi Niwa
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Manabu Doyu
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Koki Fujimori
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shiho Nakamura
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Fumiko Ozawa
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoru Morimoto
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazunari Onodera
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Takuji Ito
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Yohei Okada
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
- Aichi Medical University, Nagakute, Aichi, Japan
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3
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Ahangaran M, Chiò A, D'Ovidio F, Manera U, Vasta R, Canosa A, Moglia C, Calvo A, Minaei-Bidgoli B, Jahed-Motlagh MR. Causal associations of genetic factors with clinical progression in amyotrophic lateral sclerosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 216:106681. [PMID: 35151113 DOI: 10.1016/j.cmpb.2022.106681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/08/2022] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Recent advances in the genetic causes of ALS reveals that about 10% of ALS patients have a genetic origin and that more than 30 genes are likely to contribute to this disease. However, four genes are more frequently associated with ALS: C9ORF72, TARDBP, SOD1, and FUS. The relationship between genetic factors and ALS progression rate is not clear. In this study, we carried out a causal analysis of ALS disease with a genetics perspective in order to assess the contribution of the four mentioned genes to the progression rate of ALS. METHODS In this work, we applied a novel causal learning model to the CRESLA dataset which is a longitudinal clinical dataset of ALS patients including genetic information of such patients. This study aims to discover the relationship between four mentioned genes and ALS progression rate from a causation perspective using machine learning and probabilistic methods. RESULTS The results indicate a meaningful association between genetic factors and ALS progression rate with causality viewpoint. Our findings revealed that causal relationships between ALSFRS-R items associated with bulbar regions have the strongest association with genetic factors, especially C9ORF72; and other three genes have the greatest contribution to the respiratory ALSFRS-R items with a causation point of view. CONCLUSIONS The findings revealed that genetic factors have a significant causal effect on the rate of ALS progression. Since C9ORF72 patients have higher proportion compared to those carrying other three gene mutations in the CRESLA cohort, we need a large multi-centric study to better analyze SOD1, TARDBP and FUS contribution to the ALS clinical progression. We conclude that causal associations between ALSFRS-R clinical factors is a suitable predictor for designing a prognostic model of ALS.
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Affiliation(s)
- Meysam Ahangaran
- Department of Computer Engineering, Iran University of Science and Technology, Tehran, Iran; Department of Computer Engineering, Mazandaran University of Science and Technology, Babol, Iran.
| | - Adriano Chiò
- Department of Computer Engineering, Mazandaran University of Science and Technology, Babol, Iran; 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy; Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy; National Research Council, Institute of Cognitive Sciences and Technologies, Rome, Italy.
| | - Fabrizio D'Ovidio
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Umberto Manera
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Rosario Vasta
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy; Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy; Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy; Neurology 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza of Torino, Turin, Italy
| | - Behrouz Minaei-Bidgoli
- Department of Computer Engineering, Iran University of Science and Technology, Tehran, Iran
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4
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Ikenaka K, Maeda Y, Hotta Y, Nagano S, Yamada S, Ito D, Torii R, Kakuda K, Tatebe H, Atsuta N, Aguirre C, Kimura Y, Baba K, Tokuda T, Katsuno M, Kimura K, Sobue G, Mochizuki H. Serum asymmetric dimethyl arginine level correlates with the progression and prognosis of amyotrophic lateral sclerosis. Eur J Neurol 2022; 29:1410-1416. [PMID: 35128793 PMCID: PMC9305138 DOI: 10.1111/ene.15254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose: Methods Results Conclusion
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Affiliation(s)
- Kensuke Ikenaka
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Yasuhiro Maeda
- Center for Joint Research Facilities Support Fujita Health University Toyoake Japan
| | - Yuji Hotta
- Department of Hospital Pharmacy Nagoya City University Graduate School of Pharmaceutical Sciences Nagoya Japan
| | - Seiichi Nagano
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Shinichiro Yamada
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Daisuke Ito
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Ryota Torii
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Keita Kakuda
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Harutsugu Tatebe
- T Brothers Corporation T & Chiba Japan
- National Institutes for Quantum and Radiological Science and Technology (QST) Chiba Japan
| | - Naoki Atsuta
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
- Department of Neurology Aichi Medical University School of Medicine Nagakute Japan
| | - Cesar Aguirre
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Yasuyoshi Kimura
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Kousuke Baba
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
| | - Takahiko Tokuda
- T Brothers Corporation T & Chiba Japan
- National Institutes for Quantum and Radiological Science and Technology (QST) Chiba Japan
| | - Masahisa Katsuno
- Department of Neurology Nagoya University Graduate School of Medicine Nagoya Japan
- Department of Clinical Research Education Nagoya University Graduate School of Medicine Nagoya Japan
| | - Kazunori Kimura
- Department of Hospital Pharmacy Nagoya City University Graduate School of Pharmaceutical Sciences Nagoya Japan
| | - Gen Sobue
- Research Division of Dementia and Neurodegenerative Disease Nagoya University Graduate School of Medicine Nagoya Japan
- Aichi Medical University Nagakute Japan
| | - Hideki Mochizuki
- Department of Neurology Osaka University Graduate School of Medicine Suita Japan
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5
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He Z, Sun B, Feng F, Bai J, Wang H, Wang H, Yang F, Cui F, Huang X. Time of symptoms beyond the bulbar region predicts survival in bulbar onset amyotrophic lateral sclerosis. Neurol Sci 2021; 43:1817-1822. [PMID: 34383162 DOI: 10.1007/s10072-021-05556-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Spreading pattern and time interval of spreading are getting more and more attention. The aim of present study was to investigate spreading pattern in bulbar onset ALS patients and to explore the relationship between time interval of spreading and survival. METHODS ALS patients with bulbar onset diagnosed at Chinese PLA General Hospital from January 2015 to December 2018 were recruited. Clinical features including gender, onset age, diagnostic delay, the second involved region (SIR), time of symptoms beyond the bulbar region, forced vital capacity (FVC), ALSFRS-R score, electromyography results, and survival time were retrospectively collected. RESULTS A total of 96 bulbar onset ALS patients were collected. Overall patients showed female predominance. Median age at onset was 56 years. Median diagnostic delay was 8.5 months. Median time of symptoms beyond the bulbar region (TBBR) was 7 months. Median ALSFRS-R score at baseline was 40. Fifty-six (58.3%) patients' SIR were upper limb, 6 (6.3%) patients' SIR were lower limb, 3 (3.1%) patients' SIR were upper and lower limbs, and 5 (5.2%) patients' SIR were thoracic region. Twenty-six (27.1%) patients did not report SIR. The median survival time of patients with TBBR ≥ 7 months was significantly longer than that with TBBR < 7 month. Multivariate Cox regression showed that onset age and TBBR were prognostic factors. CONCLUSIONS In bulbar onset ALS patients, cervical region is the second most common SIR. TBBR is an independent prognostic factor.
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Affiliation(s)
- Zhengqing He
- Medical School of Chinese PLA, Beijing, China.,Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Bo Sun
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,Geriatric Neurological Department of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Feng Feng
- Department of Neurology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jiongming Bai
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Haoran Wang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,College of Medicine, Nankai University, Tianjin, China
| | - Hongfen Wang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Fei Yang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Fang Cui
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.,Department of Neurology, Hainan Hospital of PLA General Hospital, Hainan, China
| | - Xusheng Huang
- Medical School of Chinese PLA, Beijing, China. .,Neurological Department of the First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
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Salvioni C, Oda AL, Orsini M, Pauli M, Frabasile LM, Alves PCL, Borges RM, Sierra HNM, Menegatti G, Ottoboni Pinho M, Souza Bulle Oliveira A. Association between Body Composition and Dysphagia in Patients with Amyotrophic Lateral Sclerosis. Neurol Int 2021; 13:315-327. [PMID: 34294670 PMCID: PMC8299330 DOI: 10.3390/neurolint13030032] [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: 04/07/2021] [Revised: 06/01/2021] [Accepted: 07/07/2021] [Indexed: 01/01/2023] Open
Abstract
Background: The influence of changes in body composition on swallowing in patients with Amyotrophic Lateral Sclerosis (ALS) is unknown. Understanding the interrelation between body compartments and dysphagia may establish specific treatments related to both nutritional aspects as to myofunctional ones designed to delay swallowing loss. Aim: The aim of the study was to evaluate the relationship between body composition and dysphagia during the course of the disease. Methods: The protocol of this study included assessments carried out quarterly for one year and included: analysis of body composition by multi-frequency segmental bioimpedance, nutritional diagnosis, maximum strength test of the tongue and lips, analysis of swallowing using the Functional Oral Intake Score (FOIS) and Swallowing Rating Scale of the American Speech-Language-Hearing Association (ASHA), speech intelligibility and analysis of disease severity. To measure the degree of relationship between quantitative variables, Spearman’s correlation was used. Results: Thirty-four patients were evaluated, 28 Spinal Group and 6 Bulbar Group. The results did not show any significant differences in the analysis of body composition between the groups. Positive associations were found between body compartments and swallowing analysis. The phase angle showed a strong correlation between the FOIS scales (r = 0.74, p < 0.01), ASHA (r = 0.77, p < 0.01) and tongue (r = 0.66, p < 0.01). Conclusions: Changes in body compartments were related to swallowing functionality and speech intelligibility in ALS patients, emphasizing the importance of analyzing body compartments for decision making by the interdisciplinary team. Although these preliminary data were collected in a small sample size, they serve to motivate future studies in this area.
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Affiliation(s)
- Cristina Salvioni
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
- Correspondence:
| | - Adriana Leico Oda
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Marco Orsini
- Department of Medicine, Iguacu University—UNIG and Master Program in Neurology—Vassouras University—USS, 28300-000 Rio de Janeiro, Brazil;
| | - Michele Pauli
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Luciana M. Frabasile
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Percilia C. L. Alves
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Rosana M. Borges
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Helena N. M. Sierra
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Gabriela Menegatti
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Márcio Ottoboni Pinho
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
| | - Acary Souza Bulle Oliveira
- Department of Clinical Neurology, Federal University of Sao Paulo, 04023-900 Sao Paulo, Brazil; (A.L.O.); (M.P.); (L.M.F.); (P.C.L.A.); (R.M.B.); (H.N.M.S.); (G.M.); (M.O.P.); (A.S.B.O.)
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7
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Oda S, Sano T, Nishikawa N, Mikasa M, Takahashi Y, Takao M. [Amyotrophic lateral sclerosis with muscle weakness and dropped head during the course of Parkinson's disease: an autopsy case]. Rinsho Shinkeigaku 2021; 61:373-377. [PMID: 34011808 DOI: 10.5692/clinicalneurol.cn-001546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 64-year-old female developed Parkinson's disease at the age of 52 years. She experienced muscle weakness in the upper right extremities and dropped head at 62 and 63 years, respectively; both symptoms were considered to be associated with Parkinson's disease (PD). The dosage of L-DOPA was increased from 200 mg/day to 900 mg/day; however, her neurological symptoms did not improve. Eventually, she was diagnosed with amyotrophic lateral sclerosis (ALS) at 64 years. She was placed under palliative care, and died of respiratory failure and malnutrition. Neuropathologic findings were consistent with the coexistence of PD and ALS. In fact, there were α-synuclein immunoreactive Lewy bodies (Braak stage 4) as well as TDP-43 immunoreactive deposits in the motor nuclei at the level of brainstem and spinal cord. Therefore, coexisting pathologies must be taken into account in a patient showing multi-system symptoms.
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Affiliation(s)
- Shinji Oda
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry
| | - Terunori Sano
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry
| | - Noriko Nishikawa
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry
| | - Michita Mikasa
- Department of Neurology, Tokyo Metropolitan Hiroo Hospital
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry
| | - Masaki Takao
- Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry
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8
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Vasta R, Torrieri MC, D'Ovidio F, Circiello A, De Mattei F, Manera U, Canosa A, Calvo A, Chiò A, Moglia C. Neck flexor weakness at diagnosis predicts respiratory impairment in amyotrophic lateral sclerosis. Eur J Neurol 2020; 28:1181-1187. [PMID: 33314477 DOI: 10.1111/ene.14676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The purpose was to assess the prognostic role of neck muscle weakness at diagnosis in amyotrophic lateral sclerosis (ALS) patients with respect to survival and respiratory impairment. METHODS A retrospective cohort study was conducted. All ALS patients seen in the Turin ALS Centre from 2007 to 2014 were included. Muscle strength at diagnosis was evaluated using the Medical Research Council (MRC) scale. Survival was considered as the time from diagnosis to death or tracheostomy; time to respiratory impairment was considered as the interval from diagnosis to the first event amongst an ALS Functional Rating Scale revised item 10 <4, forced vital capacity <70%, start of non-invasive ventilation or tracheostomy. Time from diagnosis to dysarthria, dysphagia and walking impairment were considered as secondary outcomes. Cox proportional hazard regression models adjusted for sex, age at diagnosis, diagnostic delay, onset site, genetics status and the MRC scores of other muscle groups were used to assess the prognostic role of neck muscles. RESULTS A total of 370 patients were included in the study. Fifty-nine (15.9%) patients showed neck flexor weakness at diagnosis; MRC values were mostly in agreement for neck extensors. Neck flexors were the only muscles able to predict survival (hazard ratio 0.49, 95% confidence interval 0.28-0.86; p = 0.01). Furthermore, neck flexor normal strength decreased the risk of respiratory impairment (hazard ratio 0.46, 95% confidence interval 0.22-0.96; p = 0.04) but did not influence any secondary outcomes. DISCUSSION Neck flexor weakness at diagnosis predicts survival and respiratory impairment in ALS. This result could be valuable for both planning of patients' interventions and clinical trials' design.
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Affiliation(s)
- Rosario Vasta
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Maria Claudia Torrieri
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Fabrizio D'Ovidio
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Alberta Circiello
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Filippo De Mattei
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Umberto Manera
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Antonio Canosa
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Calvo
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Adriano Chiò
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Moglia
- ALS Centre, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Neurology 1, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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9
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Sakurai T, Hirano S, Abe M, Uji Y, Shimizu K, Suzuki M, Nakano Y, Ishikawa A, Kojima K, Shibuya K, Murata A, Kuwabara S. Dysfunction of the left angular gyrus may be associated with writing errors in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:267-275. [PMID: 33331163 DOI: 10.1080/21678421.2020.1861021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Language dysfunction is a feature of cognitive impairment in amyotrophic lateral sclerosis (ALS) that may compromise communication. Objective: To elucidate language dysfunction in patients with ALS and its relationship with other neuropsychological tests and to identify the brain regions associated with this dysfunction using perfusion image. Methods: Overall, 37 patients with ALS were included in this study. Their neuropsychological function was investigated using the Western Aphasia Battery (WAB), Frontal Assessment Battery and Behavioral Assessment of the Dysexecutive Syndrome. N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography was used to examine regional cerebral blood flow and its relationship with WAB scores was investigated using multiple regression analyses, controlled for age, sex and years of education. Results: Frequency of language abnormality in ALS was 8.5% for spontaneous speech, 25.7% for auditory verbal comprehension, 8.8% for repetition, 14.7% for naming, 17.6% for reading and 51.4% for writing. The writing error was mainly omission and substitution of kana letters. Executive tests were correlated with naming (r > 0.5, p < 0.001) and reading (r > 0.4, p < 0.01) scores. With respect to the writing sub-test, positive perfusional relationship was only detected in the left angular gyrus. Conclusions: The left angular gyrus is the region associated with the writing errors observed in ALS.
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Affiliation(s)
- Toru Sakurai
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Midori Abe
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | - Yuriko Uji
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | | | - Masahide Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshikazu Nakano
- Department of Neurology, Chiba Saiseikai Narashino Hospital, Chiba, Japan
| | - Ai Ishikawa
- Department of Neurology, Chiba East Hospital, Chiba, Japan
| | - Kazuho Kojima
- Department of Neurology, Chiba Rosai Hospital, Chiba, Japan
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Murata
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan.,Department of Rehabilitation, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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10
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Pinto S, Gromicho M, Swash M, deCarvalho M. Cervical muscle weakness is a marker of respiratory dysfunction in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2020; 91:323-324. [PMID: 31694878 DOI: 10.1136/jnnp-2019-321077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Susana Pinto
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal .,Department of Community Medicine and Rehabilitation, Umea University Department of Community Medicine and Rehabilitation, Umea, Sweden
| | - Marta Gromicho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Michael Swash
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Mamede deCarvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Centro Hospitalar Universitário de Lisboa-Norte, Lisbon, Portugal
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11
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Theme 10 Disease stratification and phenotyping of patients. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:289-300. [DOI: 10.1080/21678421.2019.1646998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Krieg I, Dalin D, Heimbach B, Wiesmeier IK, Maurer C. Abnormal trunk control determines postural abnormalities in Amyotrophic Lateral Sclerosis. NeuroRehabilitation 2019; 44:599-608. [PMID: 31256087 PMCID: PMC6700719 DOI: 10.3233/nre-192698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND: Postural instability in Amyotrophic Lateral Sclerosis (ALS) occurs at an early stage of the disease and often results in falls. As ALS is considered a multisystem neurodegenerative disorder, postural instability may result from motor, sensory and central processing deficits. OBJECTIVE AND METHODS: We analysed postural control of 12 ALS patients and 12 healthy age-matched control subjects. Postural control was characterised by spontaneous sway measures and measures of postural reactions to pseudorandom anterior-posterior platform tilts, which were then correlated with clinical test scores. RESULTS: Spontaneous sway amplitudes and velocities were significantly larger and sway frequencies higher in ALS patients than in control subjects. ALS patients’ body excursions following platform tilts were smaller, with relatively higher upper body excursions. We found high correlations between abnormal postural reactions and clinical tests representing motor or balance deficits. CONCLUSIONS: We conclude that ALS patients’ postural abnormalities are mainly determined by an abnormal axial control and abnormally small body excursions as a function of support surface tilts, seemingly indicating better postural stabilization than control subjects. The latter contradicts the hypothesis that muscle weakness is the main source for this deficit. Instead, we suggest an altered central control strategy.
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Affiliation(s)
- Iris Krieg
- Department of Neurology and Neurophysiology, University Medical Center, Medical Faculty, Freiburg, Germany
| | - Daniela Dalin
- Department of Neurology and Neurophysiology, University Medical Center, Medical Faculty, Freiburg, Germany
| | - Bernhard Heimbach
- Department of Neurology and Neurophysiology, University Medical Center, Medical Faculty, Freiburg, Germany
| | | | - Christoph Maurer
- Department of Neurology and Neurophysiology, University Medical Center, Medical Faculty, Freiburg, Germany
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13
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Zhang H, Chang BC, Andrews J, Mitsumoto H, Agrawal S. A robotic neck brace to characterize head-neck motion and muscle electromyography in subjects with amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2019; 6:1671-1680. [PMID: 31392848 PMCID: PMC6764623 DOI: 10.1002/acn3.50864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022] Open
Abstract
Objective This paper presents the first study where a dynamic neck brace was used to characterize the head motion of ALS patients while concurrently recording the surface electromyography (EMG) of the neck muscles. Methods Eleven ALS patients and 10 age‐matched healthy controls consented and participated in an experiment. Each participant was asked to perform three single‐plane motions of the head‐neck that included flexion–extension in the sagittal plane, lateral bending in the coronal plane, and axial rotation in the transverse plane. Each motion was performed in a cycle and was repeated five times at self‐selected speeds. Results During single‐plane flexion–extension under gravity, compared to healthy peers, ALS patients showed a shorter duration to reach the maximum flexion and an earlier EMG onset in the neck extensors starting from the neutral. The brace measures in activation of the neck muscles in ALS patients were well correlated with clinically measured scores, such as the ALSFRS‐r and the FVC. The activation duration of sternocleidomastoid, used to rotate the head, correlated well with the ALSFRS‐r and FVC in ALS patients during axial rotation. Interpretation The ability to synchronously activate a pair of muscles to execute single‐plane motions in ALS patients seems to have been compromised due to the disease and potentially results in head drop. The neck brace measures can be adapted in the clinic to complement self‐reporting in ALS patients and used to assess the head drop and progress of the disease.
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Affiliation(s)
- Haohan Zhang
- Department of Mechanical Engineering, Columbia University, New York, New York, 10027
| | - Biing-Chwen Chang
- Department of Mechanical Engineering, Columbia University, New York, New York, 10027
| | - Jinsy Andrews
- The Eleanor and Lou Gehrig ALS Center, Department of Neurology, Columbia University, New York, New York, 10032
| | - Hiroshi Mitsumoto
- The Eleanor and Lou Gehrig ALS Center, Department of Neurology, Columbia University, New York, New York, 10032
| | - Sunil Agrawal
- Department of Mechanical Engineering, Columbia University, New York, New York, 10027.,Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, 10032
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14
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Ikenaka K, Atsuta N, Maeda Y, Hotta Y, Nakamura R, Kawai K, Yokoi D, Hirakawa A, Taniguchi A, Morita M, Mizoguchi K, Mochizuki H, Kimura K, Katsuno M, Sobue G. Increase of arginine dimethylation correlates with the progression and prognosis of ALS. Neurology 2019; 92:e1868-e1877. [PMID: 30867270 DOI: 10.1212/wnl.0000000000007311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/17/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate whether arginine methylation is altered in patients with amyotrophic lateral sclerosis (ALS) and how it affects disease severity, progression, and prognosis. METHODS We compared the immunoreactivity of protein arginine methyltransferase 1 (PRMT1) and its products, asymmetric dimethylated proteins (ASYM), in postmortem spinal cord. We also measured the concentrations of total l-arginine and methylated arginine residues, including asymmetric dimethyl l-arginine (ADMA), symmetric dimethyl arginine, and monomethyl arginine, in CSF samples from 52 patients with ALS using liquid chromatography-tandem mass spectrometry, and we examined their relationship with the progression and prognosis of ALS. RESULTS The immunoreactivity of both PRMT1 (p < 0.0001) and ASYM (p = 0.005) was increased in patients with ALS. The concentration of ADMA in CSF was substantially higher in patients with ALS than in disease controls. The ADMA/l-arginine ratio was correlated with the change of decline in the ALS Functional Rating Scale at 12 months after the time of measurement (r = 0.406, p = 0.010). A Cox proportional hazards model showed that the ADMA/l-arginine ratio was an independent predictor for overall survival. Moreover, a high ADMA/l-arginine ratio predicted poor prognosis, even in a group with normal percentage forced vital capacity. CONCLUSION There was an enhancement of arginine dimethylation in patients with ALS, and the ADMA/l-arginine ratio predicted disease progression and prognosis in such patients.
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Affiliation(s)
- Kensuke Ikenaka
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Naoki Atsuta
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Yasuhiro Maeda
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Yuji Hotta
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Ryoichi Nakamura
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Kaori Kawai
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Daichi Yokoi
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Akihiro Hirakawa
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Akira Taniguchi
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Mitsuya Morita
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Kouichi Mizoguchi
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Hideki Mochizuki
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Kazunori Kimura
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Masahisa Katsuno
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan
| | - Gen Sobue
- From the Department of Neurology (K.I., N.A., R.N., K. Kawai, D.Y., M.K., G.S.), Nagoya University Graduate School of Medicine; Department of Neurology (K.I., H.M.), Osaka University Graduate School of Medicine, Suita; Department of Hospital Pharmacy (Y.M., Y.H., K. Kimura), Nagoya City University Graduate School of Pharmaceutical Sciences; Department of Biostatistics and Bioinformatics (A.H.), University of Tokyo; Department of Neurology (A.T.), Mie University Graduate School of Medicine, Tsu; Department of Neurology (M.M.), Jichi Medical University, Shimotsuke, Tochigi; National Hospital Organization, Shizuoka Medical Center (K.M.); and Brain and Mind Research Center (G.S.), Nagoya University, Aichi, Japan.
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15
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Seven YB, Mitchell GS. Mechanisms of compensatory plasticity for respiratory motor neuron death. Respir Physiol Neurobiol 2019; 265:32-39. [PMID: 30625378 DOI: 10.1016/j.resp.2019.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 02/06/2023]
Abstract
Respiratory motor neuron death arises from multiple neurodegenerative and traumatic neuromuscular disorders. Despite motor neuron death, compensatory mechanisms minimize its functional impact by harnessing intrinsic mechanisms of compensatory respiratory plasticity. However, the capacity for compensation eventually reaches limits and pathology ensues. Initially, challenges to the system such as increased metabolic demand reveal sub-clinical pathology. With greater motor neuron loss, the eventual result is de-compensation, ventilatory failure, ventilator dependence and then death. In this brief review, we discuss recent advances in our understanding of mechanisms giving rise to compensatory respiratory plasticity in response to respiratory motor neuron death including: 1) increased central respiratory drive, 2) plasticity in synapses on spared phrenic motor neurons, 3) enhanced neuromuscular transmission and 4) shifts in respiratory muscle utilization from more affected to less affected motor pools. Some of these compensatory mechanisms may prolong breathing function, but hasten the demise of surviving motor neurons. Improved understanding of these mechanisms and their impact on survival of spared motor neurons will guide future efforts to develop therapeutic interventions that preserve respiratory function with neuromuscular injury/disease.
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Affiliation(s)
- Yasin B Seven
- Center for Respiratory Research and Rehabilitation, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL, 32610, USA
| | - Gordon S Mitchell
- Center for Respiratory Research and Rehabilitation, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL, 32610, USA.
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16
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The clinical assessment of amyotrophic lateral sclerosis patients' prognosis by ZNF512B gene, neck flexor muscle power score and body mass index (BMI). BMC Neurol 2018; 18:211. [PMID: 30567526 PMCID: PMC6299516 DOI: 10.1186/s12883-018-1219-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Assessment on the prognosis of amyotrophic lateral sclerosis (ALS) is becoming a focus of research in recent years since there is no effective treatment. The aim of the research is to explore the major factors involving in prognosis of ALS patients through long-term follow-up. METHODS ALS patients' DNA extracted from peripheral blood white cells were detected for the risk allele by single nucleotide polymorphism (SNP) analysis. Neck flexor muscle score and body mass index (BMI) were recorded during Medical Research Council follow-up using manual muscle testing method. RESULTS ALS patients with risk alleles (C) deteriorated rapidly with poor clinical outcome. It seemed that the higher neck flexor muscle strength score in ALS patients with the longer survival time but without significant correlation (p > 0.05). The lower the basal body mass index, the shorter the survival time and the faster deterioration (p < 0.05). The patients with body mass index less than 22.04 seemed to have short survival time than those with BMI more than 22.04 (p < 0.05), however, the speed of deterioration in two groups of patients had no significant difference (p > 0.05). CONCLUSION The risk (C) allele of the SNP (rs2275294) in the ZNF512B gene, cervical flexor muscle power and body weight index might have clinical potential for ALS prognostication, since these indicators is so simple to perform that they might be very suitable for primary clinics and even community medical institutions to carry out.
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17
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Modeling sporadic ALS in iPSC-derived motor neurons identifies a potential therapeutic agent. Nat Med 2018; 24:1579-1589. [PMID: 30127392 DOI: 10.1038/s41591-018-0140-5] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/11/2018] [Indexed: 12/21/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a heterogeneous motor neuron disease for which no effective treatment is available, despite decades of research into SOD1-mutant familial ALS (FALS). The majority of ALS patients have no familial history, making the modeling of sporadic ALS (SALS) essential to the development of ALS therapeutics. However, as mutations underlying ALS pathogenesis have not yet been identified, it remains difficult to establish useful models of SALS. Using induced pluripotent stem cell (iPSC) technology to generate stem and differentiated cells retaining the patients' full genetic information, we have established a large number of in vitro cellular models of SALS. These models showed phenotypic differences in their pattern of neuronal degeneration, types of abnormal protein aggregates, cell death mechanisms, and onset and progression of these phenotypes in vitro among cases. We therefore developed a system for case clustering capable of subdividing these heterogeneous SALS models by their in vitro characteristics. We further evaluated multiple-phenotype rescue of these subclassified SALS models using agents selected from non-SOD1 FALS models, and identified ropinirole as a potential therapeutic candidate. Integration of the datasets acquired in this study permitted the visualization of molecular pathologies shared across a wide range of SALS models.
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18
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Takei K, Tsuda K, Takahashi F, Hirai M, Palumbo J. An assessment of treatment guidelines, clinical practices, demographics, and progression of disease among patients with amyotrophic lateral sclerosis in Japan, the United States, and Europe. Amyotroph Lateral Scler Frontotemporal Degener 2018; 18:88-97. [PMID: 28872912 DOI: 10.1080/21678421.2017.1361445] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is an increasing clinical research focus on neuroprotective agents in amyotrophic lateral sclerosis (ALS). However, it is unclear how generalisable clinical study trial results are between different countries and regions. OBJECTIVE To assess similarities and differences in clinical practice and treatment guidelines for ALS, and also to compare the demographics and rate of progression of disease in patients with ALS enrolled in clinical trials in Japan, the US, and Europe. METHODS We performed a review of clinical studies published since 2000 to compare the demographics and characteristics of patients with ALS. Progression of ALS disease was assessed in patients receiving placebo. The changes per month in ALSFRS-R score were calculated and compared between the studies. RESULTS Overall, diagnostic criteria, recognition of ALS symptoms, comorbidities, use of riluzole, and nutritional, and respiratory support were similar. Regarding demographics and characteristics, there were no clear differences in the incidence of sporadic ALS (range 91-98%), bulbar onset (range 11-41%), and median time from onset to diagnosis (range 9-14 months) among the populations despite the difference in race between regions. However, use of tracheostomy-based invasive respiratory support was higher in Japan (29-38%) than in the US (4%) and Europe (1-31%). Rate of progression of disease was similar between the US and Europe study populations (range -0.89 to -1.60 points/month), and the Japanese study populations (range -1.03 to -1.21 points/month). CONCLUSION There is evidence to support the generalisability of data from the Japanese ALS trial experience to the US and Europe populations in early to mid-stage of ALS.
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Affiliation(s)
- Koji Takei
- a Mitsubishi Tanabe Pharma Development America Inc. , Jersey City , NJ , USA and
| | - Kikumi Tsuda
- a Mitsubishi Tanabe Pharma Development America Inc. , Jersey City , NJ , USA and
| | | | - Manabu Hirai
- b Mitsubishi Tanabe Pharma Corporation , Tokyo , Japan
| | - Joseph Palumbo
- a Mitsubishi Tanabe Pharma Development America Inc. , Jersey City , NJ , USA and.,b Mitsubishi Tanabe Pharma Corporation , Tokyo , Japan
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19
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Senda J, Atsuta N, Watanabe H, Bagarinao E, Imai K, Yokoi D, Riku Y, Masuda M, Nakamura R, Watanabe H, Ito M, Katsuno M, Naganawa S, Sobue G. Structural MRI correlates of amyotrophic lateral sclerosis progression. J Neurol Neurosurg Psychiatry 2017; 88:901-907. [PMID: 28501822 DOI: 10.1136/jnnp-2016-314337] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 02/09/2017] [Accepted: 03/06/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE Amyotrophic lateral sclerosis (ALS) presents with varying degrees of brain degeneration that can extend beyond the corticospinal tract (CST). Furthermore, the clinical course and progression of ALS varies widely. Brain degeneration detected using structural MRI could reflect disease progression. SUBJECTS AND METHODS On study registration, 3-Tesla volumetric MRI and diffusion tensor imaging scans were obtained at baseline in 38 healthy controls and 67 patients with sporadic ALS. Patients had Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) scores of ≥36 and did not have the chromosome 9, open reading frame 72 repeat expansion. Six months later, changes in ALSFRS-R (ΔALSFRS-R) scores were calculated and patients were grouped into three categories, namely, patients with slow progression with ΔALSFRS-R scores ≤3 (n=19), intermediate progression with ΔALSFRS-R scores =4, 5 and 6 (n=36) and rapid progression with ΔALSFRS-R scores ≥7 (n=12). We analysed voxel-based morphometry and tract-based spatial statistics among these subgroups and controls. RESULTS In comparison with controls, patients with ALS showed grey matter atrophy and decreased fractional anisotropy beyond the motor cortex and CST, especially in the frontotemporal lobes and basal ganglia. Moreover, the degree of change was highly proportional to ΔALSFRS-R at the 6-month assessment. CONCLUSION A more rapid disease progression and poorer functional decline were associated with greater involvement of the extra-motor cortex and basal ganglia, suggesting that the spatial extent of brain involvement can be an indicator of the progression in ALS.
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Affiliation(s)
- Joe Senda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, Aichi, Japan
| | - Naoki Atsuta
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | | | - Kazunori Imai
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Daichi Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuichi Riku
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryoichi Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hazuki Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan.,Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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20
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Seven YB, Nichols NL, Kelly MN, Hobson OR, Satriotomo I, Mitchell GS. Compensatory plasticity in diaphragm and intercostal muscle utilization in a rat model of ALS. Exp Neurol 2017; 299:148-156. [PMID: 29056361 DOI: 10.1016/j.expneurol.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/29/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022]
Abstract
In SOD1G93A transgenic rat model of ALS, breathing capacity is preserved until late in disease progression despite profound respiratory motor neuron (MN) cell death. To explore mechanisms preserving breathing capacity, we assessed inspiratory EMG activity in diaphragm and external intercostal T2 (EIC2) and T5 (EIC5) muscles in anesthetized SOD1G93A rats at disease end-stage (20% decrease in body mass). We hypothesized that despite significant phrenic motor neuron loss and decreased phrenic nerve activity, diaphragm electrical activity and trans-diaphragmatic pressure (Pdi) are maintained to sustain ventilation. We alternatively hypothesized that EIC activity is enhanced, compensating for impaired diaphragm function. Diaphragm, EIC2 and EIC5 muscle EMGs and Pdi were measured in urethane-anesthetized, spontaneously breathing female SOD1G93A rats versus wild-type littermates during normoxia (arterial PO2 ~90mmHg, PCO2 ~45mmHg), maximal chemoreceptor stimulation (MCS: 10.5% O2/7% CO2), spontaneous augmented breaths and sustained tracheal occlusion. Phrenic MNs were counted in C3-5; T2 and T5 ventrolateral MNs were counted. In end-stage SOD1G93A rats, 29% of phrenic MNs survived (vs. wild-type), yet integrated diaphragm EMG amplitude was normal. Nevertheless, maximal Pdi decreased ~30% vs. wild type (p<0.01) and increased esophageal to gastric pressure ratio (p<0.05), consistent with persistent diaphragm weakness. Despite major T2 and T5 MN death, integrated EIC2 (100% greater than wild type) and EIC5 (300%) EMG amplitudes were increased in mutant rats during normoxia (p<0.01), possibly compensating for decreased Pdi. Thus, despite significant phrenic MN loss, diaphragm EMG activity is maintained; in contrast, Pdi was not, suggesting diaphragm dysfunction. Presumably, increased EIC EMG activity compensated for persistent diaphragm weakness. These adjustments contribute to remarkable preservation of breathing ability despite major respiratory motor neuron death and diaphragm dysfunction.
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Affiliation(s)
- Yasin B Seven
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; Center for Respiratory Research and Rehabilitation, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA
| | - Nicole L Nichols
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
| | - Mia N Kelly
- Center for Respiratory Research and Rehabilitation, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA
| | - Orinda R Hobson
- Center for Respiratory Research and Rehabilitation, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA
| | - Irawan Satriotomo
- Center for Respiratory Research and Rehabilitation, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA
| | - Gordon S Mitchell
- Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA; Center for Respiratory Research and Rehabilitation, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA.
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21
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Pancani S, Tindale W, Shaw PJ, McDermott CJ, Mazzà C. An Objective Functional Characterisation of Head Movement Impairment in Individuals with Neck Muscle Weakness Due to Amyotrophic Lateral Sclerosis. PLoS One 2017; 12:e0169019. [PMID: 28068376 PMCID: PMC5222498 DOI: 10.1371/journal.pone.0169019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background Neck muscle weakness and head drop are well recognised in patients with Amyotrophic lateral sclerosis (ALS), but an objective characterisation of the consequent head movement impairment is lacking. The aim of this study was to quantitatively characterise head movements in ALS compared to aged matched controls. Methods We evaluated two groups, one of thirteen patients with ALS and one of thirteen age-matched controls, during the execution of a series of controlled head movements, performed while wearing two inertial sensors attached on the forehead and sternum, respectively. We quantified the differences between the two groups from the sensor data using indices of velocity, smoothness and movement coupling (intended as a measure of undesired out of plane movements). Findings Results confirmed a general limitation in the ability of the ALS patients to perform and control head movements. High inter-patient variability was observed due to a wide range of observed functional impairment levels. The ability to extend the head backward and flex it laterally were the most compromised, with significantly lower angular velocity (P < 0.05, Cohen’s d > 0.8), reduced smoothness and greater presence of coupled movements with respect to the controls. A significant reduction of angular velocity (P < 0.05, Cohen’s d > 0.8) in extension, axial rotation and lateral flexion was observed when patients were asked to perform the movements as fast as possible. Interpretation This pilot study is the first study providing a functional objective quantification of head movements in ALS. Further work involving different body areas and correlation with existing methods of evaluating neuromuscular function, such as dynamometry and EMG, is needed to explore the use of this approach as a marker of disease progression in ALS.
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Affiliation(s)
- Silvia Pancani
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Wendy Tindale
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
- NIHR Devices for Dignity Healthcare Technology Co-operative, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Christopher J. McDermott
- NIHR Devices for Dignity Healthcare Technology Co-operative, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
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22
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Knibb JA, Keren N, Kulka A, Leigh PN, Martin S, Shaw CE, Tsuda M, Al-Chalabi A. A clinical tool for predicting survival in ALS. J Neurol Neurosurg Psychiatry 2016; 87:1361-1367. [PMID: 27378085 PMCID: PMC5136716 DOI: 10.1136/jnnp-2015-312908] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/24/2016] [Accepted: 04/06/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive and usually fatal neurodegenerative disease. Survival from diagnosis varies considerably. Several prognostic factors are known, including site of onset (bulbar or limb), age at symptom onset, delay from onset to diagnosis and the use of riluzole and non-invasive ventilation (NIV). Clinicians and patients would benefit from a practical way of using these factors to provide an individualised prognosis. METHODS 575 consecutive patients with incident ALS from a population-based registry in South-East England register for ALS (SEALS) were studied. Their survival was modelled as a two-step process: the time from diagnosis to respiratory muscle involvement, followed by the time from respiratory involvement to death. The effects of predictor variables were assessed separately for each time interval. FINDINGS Younger age at symptom onset, longer delay from onset to diagnosis and riluzole use were associated with slower progression to respiratory involvement, and NIV use was associated with lower mortality after respiratory involvement, each with a clinically significant effect size. Riluzole may have a greater effect in younger patients and those with longer delay to diagnosis. A patient's survival time has a roughly 50% chance of falling between half and twice the predicted median. INTERPRETATION A simple and clinically applicable graphical method of predicting an individual patient's survival from diagnosis is presented. The model should be validated in an independent cohort, and extended to include other important prognostic factors.
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Affiliation(s)
- Jonathan A Knibb
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, UK
| | - Noa Keren
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anna Kulka
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Nigel Leigh
- Trafford Centre for Biomedical Research, Brighton and Sussex Medical School, Falmer, UK
| | - Sarah Martin
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher E Shaw
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Miho Tsuda
- Macclesfield District General Hospital, Macclesfield, Cheshire, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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23
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Shahrizaila N, Sobue G, Kuwabara S, Kim SH, Birks C, Fan DS, Bae JS, Hu CJ, Gourie-Devi M, Noto Y, Shibuya K, Goh KJ, Kaji R, Tsai CP, Cui L, Talman P, Henderson RD, Vucic S, Kiernan MC. Amyotrophic lateral sclerosis and motor neuron syndromes in Asia. J Neurol Neurosurg Psychiatry 2016; 87:821-30. [PMID: 27093948 DOI: 10.1136/jnnp-2015-312751] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
Abstract
While the past 2 decades have witnessed an increasing understanding of amyotrophic lateral sclerosis (ALS) arising from East Asia, particularly Japan, South Korea, Taiwan and China, knowledge of ALS throughout the whole of Asia remains limited. Asia represents >50% of the world population, making it host to the largest patient cohort of ALS. Furthermore, Asia represents a diverse population in terms of ethnic, social and cultural backgrounds. In this review, an overview is presented that covers what is currently known of ALS in Asia from basic epidemiology and genetic influences, through to disease characteristics including atypical phenotypes which manifest a predilection for Asians. With the recent establishment of the Pan-Asian Consortium for Treatment and Research in ALS to facilitate collaborations between clinicians and researchers across the region, it is anticipated that Asia and the Pacific will contribute to unravelling the uncertainties in ALS.
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Affiliation(s)
- N Shahrizaila
- Faculty of Medicine, Neurology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - G Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S H Kim
- Department of Neurology, Hanyang University Medical Center, Seoul, South Korea
| | - Carol Birks
- International Alliance of ALS/MND Associations, Sydney, New South Wales, Australia
| | - D S Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - J S Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - C J Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - M Gourie-Devi
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, Delhi, India
| | - Y Noto
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Shibuya
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K J Goh
- Faculty of Medicine, Neurology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - C P Tsai
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - L Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - P Talman
- Neurology Unit, Calvary Health Care, Bethlehem Hospital, Caulfield, Victoria, Australia
| | - R D Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - S Vucic
- The Brain Dynamics Centre, Westmead Millennium Institute, Westmead, NSW and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - M C Kiernan
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
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24
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Watanabe H, Atsuta N, Hirakawa A, Nakamura R, Nakatochi M, Ishigaki S, Iida A, Ikegawa S, Kubo M, Yokoi D, Watanabe H, Ito M, Katsuno M, Izumi Y, Morita M, Kanai K, Taniguchi A, Aiba I, Abe K, Mizoguchi K, Oda M, Kano O, Okamoto K, Kuwabara S, Hasegawa K, Imai T, Kawata A, Aoki M, Tsuji S, Nakashima K, Kaji R, Sobue G. A rapid functional decline type of amyotrophic lateral sclerosis is linked to low expression of TTN. J Neurol Neurosurg Psychiatry 2016; 87:851-8. [PMID: 26746183 DOI: 10.1136/jnnp-2015-311541] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/18/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To classify the patterns of functional decline in patients with sporadic amyotrophic lateral sclerosis (ALS) and explore the genetic backgrounds that modified these patterns. METHODS We included 465 patients with sporadic ALS in the analysis and clustered the longitudinal functional scores in the registered patients, using a mixture approach of a non-linear mixed-effects model. We conducted a genome-wide analysis of 572 983 single nucleotide polymorphisms (SNPs). We then assessed the association between the clusters of longitudinal functional scores and SNPs. RESULTS We identified the following four clusters of longitudinal functional decline in the cases: a rapid decline cluster, an intermediate decline cluster, a sigmoidal decline cluster and a moderate decline cluster. We identified seven SNPs associated with the rapid decline cluster, using a recessive model (p=3.47-8.34×10(-8)). The OR for the probabilities of the rapid decline cluster ranged from 5.5 to 5.84. Homozygosity for the minor alleles in the seven SNPs, which constituted a linkage disequilibrium (LD) block, was associated with decreased expression of TTN (encoding Titin, a large sarcomere protein) in the expression quantitative trait loci database of a large-scale Japanese genetic variation database (p=8.6×10(-10)-1.1×10(-7)). TTN expression in immortalised lymphocyte lines was decreased in patients who were homozygous for the minor alleles compared with those who were homozygous for the major alleles (n=19 in each group, p=0.002). CONCLUSIONS We detected an LD block associated with a rapid functional decline in patients with sporadic ALS, which is linked to decreased expression of TTN.
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Affiliation(s)
- Hazuki Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Atsuta
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirakawa
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Ryoichi Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Nakatochi
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Shinsuke Ishigaki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aritoshi Iida
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Science, RIKEN, Tokyo, Japan
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, Center for Integrative Medical Science, RIKEN, Tokyo, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Daichi Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuishin Izumi
- Department of Clinical Neuroscience, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Mitsuya Morita
- Division of Neurology, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuaki Kanai
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Koji Abe
- Department of Neurology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Koichi Mizoguchi
- Department of Neurology, National Hospital Organization, Shizuoka-Fuji National Hospital, Fujinomiya, Japan
| | - Masaya Oda
- Department of Neurology, Vihara Hananosato Hospital, Miyoshi, Japan
| | - Osamu Kano
- Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan
| | - Koichi Okamoto
- Department of Neurology, Geriatrics Research Institute, Maebashi, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuko Hasegawa
- Division of Neurology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Japan
| | - Takashi Imai
- Division of Neurology, National Hospital Organization, Miyagi National Hospital, Miyagi, Japan
| | - Akihiro Kawata
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Nakashima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryuji Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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25
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Yokoi D, Atsuta N, Watanabe H, Nakamura R, Hirakawa A, Ito M, Watanabe H, Katsuno M, Izumi Y, Morita M, Taniguchi A, Oda M, Abe K, Mizoguchi K, Kano O, Kuwabara S, Kaji R, Sobue G. Age of onset differentially influences the progression of regional dysfunction in sporadic amyotrophic lateral sclerosis. J Neurol 2016; 263:1129-36. [PMID: 27083563 DOI: 10.1007/s00415-016-8109-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/30/2022]
Abstract
The clinical courses of sporadic amyotrophic lateral sclerosis (ALS) show extensive variability. Our objective was to elucidate how age of onset influences the progression of regional symptoms and functional losses in sporadic ALS. We included 648 patients with sporadic ALS from a multicenter prospective ALS cohort. We investigated the distribution of initial symptoms and analyzed the time from onset to events affecting activities of daily living (ADL) as well as the longitudinal changes in each regional functional rating score among four groups with different ages of onset. The frequencies of dysarthria and dysphagia as initial symptoms were higher in the older age groups, whereas weakness of upper limbs was the most common initial symptom in the youngest age group. The survival times and the times from onset to loss of speech and swallowing were significantly shorter in the older age group (p < 0.001), although the times from onset to loss of upper limb function were not significantly different among the age groups. According to joint modeling analysis, the bulbar score declined faster in the older age groups (<50 vs. 60-69 years: p = 0.029, <50 vs. ≥70 years: p < 0.001), whereas there was no significant correlation between the age of onset and decline in the upper limb score. Our results showed that age of onset had a significant influence on survival time and the progression of bulbar symptoms, but had no influence on upper limb function in sporadic ALS.
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Affiliation(s)
- Daichi Yokoi
- Department of Neurology, Nagoya University, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Atsuta
- Department of Neurology, Nagoya University, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hazuki Watanabe
- Department of Neurology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan
| | - Ryoichi Nakamura
- Department of Neurology, Nagoya University, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihiro Hirakawa
- Center for Advanced Medicine and Clinical Research, Nagoya University, Nagoya, Aichi, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Nagoya University, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yuishin Izumi
- Department of Neurology, Tokushima University, Tokushima, Tokushima, Japan
| | - Mitsuya Morita
- Department of Neurology, Jichi Medical University, Shimono, Tochigi, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaya Oda
- Department of Neurology, Vihara Hananosato Hospital, Miyoshi, Hiroshima, Japan
| | - Koji Abe
- Department of Neurology, Okayama University, Okayama, Okayama, Japan
| | - Kouichi Mizoguchi
- Department of Neurology, Shizuoka Fuji Hospital, Fujinomiya, Shizuoka, Japan
| | - Osamu Kano
- Division on Neurology, Department of Internal Medicine, Toho University School of Medicine, Ota-ku, Tokyo, Japan
| | | | - Ryuji Kaji
- Department of Neurology, Tokushima University, Tokushima, Tokushima, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
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26
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Prognostic Factors in Amyotrophic Lateral Sclerosis: A Population-Based Study. PLoS One 2015; 10:e0141500. [PMID: 26517122 PMCID: PMC4627754 DOI: 10.1371/journal.pone.0141500] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/08/2015] [Indexed: 12/11/2022] Open
Abstract
Objective To determine the prognostic factors associated with survival in amyotrophic lateral sclerosis at diagnosis. Methods This retrospective population-based study evaluated 218 patients treated with riluzole between 2005 and 2014 and described their clinical and demographic profiles after the analysis of clinical data and records from the mortality information system in the Federal District, Brazil. Cox multivariate regression analysis was conducted for the parameters found. Results The study sample consisted of 132 men and 86 women with a mean age at disease onset of 57.2±12.3 years; 77.6% of them were Caucasian. The mean periods between disease onset and diagnosis were 22.7 months among men and 23.5 months among women, and the mean survival periods were 45.7±47.0 months among men and 39.3±29.8 months among women. In addition, 80.3% patients presented non-bulbar-onset amyotrophic lateral sclerosis, and 19.7% presented bulbar-onset. Cox regression analysis indicated worse prognosis for body mass index (BMI) <25 kg/m2 (relative risk [RR]: 3.56, 95% confidence interval [CI]: 1.44–8.86), age >75 years (RR: 12.47, 95% CI: 3.51–44.26), and bulbar-onset (RR: 4.56, 95% CI: 2.06–10.12). Electromyography did not confirm the diagnosis in 55.6% of the suspected cases and in 27.9% of the bulbar-onset cases. Conclusions The factors associated with lower survival in amyotrophic lateral sclerosis were age >75 years, BMI <25 kg/m2, and bulbar-onset.
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Simon NG, Turner MR, Vucic S, Al-Chalabi A, Shefner J, Lomen-Hoerth C, Kiernan MC. Quantifying disease progression in amyotrophic lateral sclerosis. Ann Neurol 2014; 76:643-57. [PMID: 25223628 PMCID: PMC4305209 DOI: 10.1002/ana.24273] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 12/28/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) exhibits characteristic variability of onset and rate of disease progression, with inherent clinical heterogeneity making disease quantitation difficult. Recent advances in understanding pathogenic mechanisms linked to the development of ALS impose an increasing need to develop strategies to predict and more objectively measure disease progression. This review explores phenotypic and genetic determinants of disease progression in ALS, and examines established and evolving biomarkers that may contribute to robust measurement in longitudinal clinical studies. With targeted neuroprotective strategies on the horizon, developing efficiencies in clinical trial design may facilitate timely entry of novel treatments into the clinic.
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Affiliation(s)
- Neil G Simon
- Department of Neurology, University of California, San Francisco, San Francisco, CA; Prince of Wales Clinical School, University of New South Wales, Randwick, Australia; Neuroscience Research Australia, Barker St, Randwick, Australia
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28
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Wakabayashi H, Sashika H, Matsushima M. Head lifting strength is associated with dysphagia and malnutrition in frail older adults. Geriatr Gerontol Int 2014; 15:410-6. [DOI: 10.1111/ggi.12283] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
- Division of Clinical Epidemiology; Jikei University School of Medicine; Tokyo Japan
| | - Hironobu Sashika
- Department of Rehabilitation Medicine; Yokohama City University Medical Center; Yokohama Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology; Jikei University School of Medicine; Tokyo Japan
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