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Rose L, Thaventhiran T, Hobson E, Rogers R, James K, Chu P, Carter B, Faull C, Saha S, Lee JS, Kaltsakas G, McDermott C, Ramsay M. Digital peer-to-peer support programme for informal caregivers of people living with motor neuron disease: study protocol for a multi-centre parallel group, single-blinded (outcome assessor) randomised controlled superiority trial. Trials 2023; 24:119. [PMID: 36805758 PMCID: PMC9940323 DOI: 10.1186/s13063-023-07124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/28/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Peer support is effective in improving psychological well-being of family caregivers of people with conditions such as dementia, cancer, and brain injury. However, there are limited data on effective psychological interventions for family caregivers of people living with motor neurone disease. Our objective is to evaluate the efficacy of a virtual peer support programme for improving caregiver psychological wellbeing and caregiving related outcomes. METHODS We will conduct a multi-centre parallel group randomised controlled superiority trial. Using a multi-modal recruitment strategy, we will recruit informal caregivers from UK MND clinics, in-patient units, and hospices. We will randomise (1:1, stratified by gender) participants to either a 12-week virtual peer support programme or usual care comprising provision of online information resources publicly available via the MND Association website. Peer support programme elements will be delivered via a secure digital e-platform aTouchAway™ (Aetonix, Canada). Our target sample size is 160 (80 each arm). Our primary outcome is the Hospital Anxiety and Depression Scale (HADS) assessed at 12 weeks (primary endpoint). Secondary outcomes that will also be assessed at 12 weeks include the Zarit Burden Interview, Pearlin Mastery Scale, Personal Gain Scale, Positive Affect Scale, and the Brief COPE. Outcome assessors will be blinded to allocation. Tertiary outcomes include perceived usability (1 item 9-point Likert scale) and acceptability (semi-structured qualitative interviews) of the peer support programme. Intervention fidelity measures will comprise frequency, type (text, audio, video), and duration (audio and video) of peer support contact downloaded from the aTouchAway AWS server. We will use a mixed-effects linear model to test the effect of the intervention on the primary outcome. Secondary outcomes will be analysed using linear regression. We have ethical approval (21/NW/0269) from the North-West Research Ethics Committee, UK. DISCUSSION This single-blinded randomised controlled trial will determine the effect of a virtual peer support programme on caregiver psychological wellbeing and caregiver burden. This study will examine the impact of a virtual peer support intervention on quality-of-life measures in informal caregivers of individuals with MND living in the community. TRIAL REGISTRATION ClinicalTrials.gov: NCT04695210.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, London, SE1 8WA, United Kingdom. .,Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE17HE, United Kingdom.
| | - Thilipan Thaventhiran
- grid.13097.3c0000 0001 2322 6764Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, James Clerk Maxwell Building, London, SE1 8WA United Kingdom
| | - Esther Hobson
- grid.11835.3e0000 0004 1936 9262Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Rd, Sheffield, S102HQ United Kingdom
| | - Rebecca Rogers
- grid.13097.3c0000 0001 2322 6764Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, James Clerk Maxwell Building, London, SE1 8WA United Kingdom
| | - Kirsty James
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, King’s College London, Psychology & NeuroscienceDe Crespigny Park, London, SE5 8AF United Kingdom
| | - Petrina Chu
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, King’s College London, Psychology & NeuroscienceDe Crespigny Park, London, SE5 8AF United Kingdom
| | - Ben Carter
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, King’s College London, Psychology & NeuroscienceDe Crespigny Park, London, SE5 8AF United Kingdom
| | | | - Sian Saha
- grid.46699.340000 0004 0391 9020King’s College Hospital, Denmark Hill, London, SE59RS United Kingdom
| | - Jeong Su Lee
- grid.420545.20000 0004 0489 3985Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE17HE United Kingdom
| | - Georgios Kaltsakas
- grid.420545.20000 0004 0489 3985Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE17HE United Kingdom ,grid.13097.3c0000 0001 2322 6764Centre for Human and Applied Physiological Sciences (CHAPS), King’s College London, London, SE1 8WA United Kingdom
| | - Christopher McDermott
- grid.11835.3e0000 0004 1936 9262Sheffield Institute for Translational Neuroscience, University of Sheffield, 385a Glossop Rd, Sheffield, S102HQ United Kingdom
| | - Michelle Ramsay
- grid.420545.20000 0004 0489 3985Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE17HE United Kingdom
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Berry JD, Blanchard M, Bonar K, Drane E, Murton M, Ploug U, Ricchetti-Masterson K, Savic N, Worthington E, Heiman-Patterson T. Epidemiology and economic burden of amyotrophic lateral sclerosis in the United States: a literature review. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-13. [PMID: 36748473 DOI: 10.1080/21678421.2023.2165947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: This review sought to gain a comprehensive, up-to-date understanding of the epidemiology and cost and healthcare resource use (HCRU) burden of amyotrophic lateral sclerosis (ALS) in the US, at a patient and national level. Methods: A targeted literature review (TLR) to identify epidemiological evidence (prevalence, incidence, mortality, survival), and systematic literature review (SLR) to identify cost and HCRU data published since January 2016, were performed. MEDLINE databases and Embase searches were conducted in January 2021. Key congresses (2019-2020) and bibliographies of relevant SLRs were hand-searched. Two high-quality SLRs were reviewed for additional cost data published between January 2001-2015. Registry and database studies were prioritized for epidemiological evidence. To allow comparison between studies in this publication, only evidence from the US was considered, with costs inflated to the 2020/2021 cost-year and converted to US dollars. Results: Eight studies from the epidemiology TLR, and eighteen from the cost and HCRU SLR, were extracted. Reported ALS incidence in the US was ∼1.5 per 100,000 person-years, and point prevalence ranged from 3.84-5.56 per 100,000 population. Total US national costs spanned ∼$212 million-∼$1.4 billion USD/year, and variably consisted of direct costs associated with HCRU and indirect costs. Conclusions: The national cost of ∼$1.02 billion USD/year (estimated using a prevalence of 16,055 cases) best aligns with prevalence estimates found in the TLR (equating to ∼13,000-18,000 cases). However, large-scale, population-based studies are necessary to precisely assess US epidemiology of ALS and capture all costs needed to inform cost-effectiveness models and resource planning.
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Affiliation(s)
- James D Berry
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
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3
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Genge A, Chio A. The future of ALS diagnosis and staging: where do we go from here? Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:165-174. [PMID: 36503299 DOI: 10.1080/21678421.2022.2150555] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare, progressive multi-system neurodegenerative disorder. Its clinical presentation varies considerably leading to delays in diagnosis, which has dire consequences in a disease where early intervention is key to optimize outcomes and limit care giver burden. There are a range of diagnostic criteria available to aid ALS diagnosis, as well staging methods to assess disease progression. However, they all suffer from inter-rater variability, complexity, and confusion in use. Such difficulties, when medical appointment times are limited and becoming more virtually based, have the potential to amplify uncertainty and errors in ALS diagnosis and prognosis. This review provides a clinical overview of the best way to balance the needs of evidence-based medicine and the patient. We focus on ALS diagnostic criteria and staging systems currently in use in clinical practice and explore factors that could enhance diagnostic efficiency and assessment of disease progression.
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Affiliation(s)
- Angela Genge
- Clinical Research Unit, ALS Clinic, Montreal, Canada and
| | - Adriano Chio
- Rita Levi Montalcini Department of Neuroscience, University of Turin, Turin, Italy
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Sturmey E, Malaspina A. Blood biomarkers in ALS: challenges, applications and novel frontiers. Acta Neurol Scand 2022; 146:375-388. [PMID: 36156207 PMCID: PMC9828487 DOI: 10.1111/ane.13698] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 01/12/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease among adults. With diagnosis reached relatively late into the disease process, extensive motor cell loss narrows the window for therapeutic opportunities. Clinical heterogeneity in ALS and the lack of disease-specific biomarkers have so far led to large-sized clinical trials with long follow-up needed to define clinical outcomes. In advanced ALS patients, there is presently limited scope to use imaging or invasive cerebrospinal fluid (CSF) collection as a source of disease biomarkers. The development of more patient-friendly and accessible blood biomarker assays is hampered by analytical hurdles like the matrix effect of blood components. However, blood also provides the opportunity to identify disease-specific adaptive changes of the stoichiometry and conformation of target proteins and the endogenous immunological response to low-abundance brain peptides, such as neurofilaments (Nf). Among those biomarkers under investigation in ALS, the change in concentration before or after diagnosis of Nf has been shown to aid prognostication and to allow the a priori stratification of ALS patients into smaller sized and clinically more homogeneous cohorts, supporting more affordable clinical trials. Here, we discuss the technical hurdles affecting reproducible and sensitive biomarker measurement in blood. We also summarize the state of the art of non-CSF biomarkers in the study of prognosis, disease progression, and treatment response. We will then address the potential as disease-specific biomarkers of the newly discovered cryptic peptides which are formed down-stream of TDP-43 loss of function, the hallmark of ALS pathobiology.
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Affiliation(s)
- Ellie Sturmey
- Centre of Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK
| | - Andrea Malaspina
- Centre of Neuroscience, Surgery and Trauma, Queen Mary University of London, London, UK.,Queen Square Institute of Neurology, University College London, London, UK
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Brooks BR, Berry JD, Ciepielewska M, Liu Y, Zambrano GS, Zhang J, Hagan M. Intravenous edaravone treatment in ALS and survival: An exploratory, retrospective, administrative claims analysis. EClinicalMedicine 2022; 52:101590. [PMID: 35958519 PMCID: PMC9358426 DOI: 10.1016/j.eclinm.2022.101590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We aimed to evaluate overall survival in US patients with amyotrophic lateral sclerosis (ALS) treated with intravenous (IV) edaravone compared with those not treated with IV edaravone in a real-world setting. METHODS This exploratory retrospective comparative effectiveness observational analysis included patients with ALS who were enrolled in an administrative claims database from 8 August 2017 to 31 March 2020. Propensity score matching identified IV edaravone-treated patients (cases) and non-edaravone-treated patients (controls) matched for covariates: age, race, geographic region, sex, pre-index disease duration, insurance, history of cardiovascular disease, riluzole prescription, gastrostomy tube placement, artificial nutrition, noninvasive ventilation, and all-cause hospitalisation. For cases, the index date was the date of the first claim for IV edaravone. For controls, it was the date IV edaravone was available (8 August 2017). The effect of IV edaravone on all-cause mortality was estimated with shared frailty Cox regression analysis. FINDINGS 318 cases were matched to 318 controls. In both groups, 208 patients (65.4%) had a history of riluzole prescription. As of 31 March 2021, there were 155 deaths (48.7%) among the cases and 196 among the controls (61.6%). Median overall survival time was 29.5 months with edaravone and 23.5 months without, respectively, and the risk of death was 27% lower in cases than in controls (HR, 0.73; 95% CI, 0.59-0.91; p=0.005). INTERPRETATION In this real-world analysis, IV edaravone treatment in a large predominantly riluzole-treated US cohort was associated with prolonged overall survival compared with not using IV edaravone. Data from adequately powered RCTs are needed to support this finding. FUNDING Funded by Mitsubishi Tanabe Pharma America.
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Affiliation(s)
- Benjamin Rix Brooks
- Atrium Health Neurosciences Institute, Carolinas Medical Center, University of North Carolina School of Medicine–Charlotte Campus, Charlotte, NC, United States
| | - James D. Berry
- Healey Center for ALS, Massachusetts General Hospital, Boston, MA, United States
| | - Malgorzata Ciepielewska
- Medical Affairs, Mitsubishi Tanabe Pharma America, Inc., Jersey City, NJ, United States
- Corresponding author at: Mitsubishi Tanabe Pharma America, Inc, 525 Washington Blvd., Suite 2620, Jersey City, NJ 07310, United States.
| | - Ying Liu
- Princeton Pharmatech, Princeton, NJ, United States
| | | | | | - Melissa Hagan
- Medical Affairs, Mitsubishi Tanabe Pharma America, Inc., Jersey City, NJ, United States
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Hu N, Ji H. Medications on hypertension, hyperlipidemia, diabetes, and risk of amyotrophic lateral sclerosis: a systematic review and meta-analysis. Neurol Sci 2022; 43:5189-5199. [DOI: 10.1007/s10072-022-06131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/11/2022] [Indexed: 02/06/2023]
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Colvin LE, Foster ZW, Stein TD, Thakore-James M, Salajegheh MK, Carr K, Spencer KR, Rauf NA, Adams L, Averill JG, Walker SE, Robey I, Alvarez VE, Huber BR, McKee AC, Kowall NW, Brady CB. Utility of the ALSFRS-R for predicting ALS and comorbid disease neuropathology: The Veterans Affairs Biorepository Brain Bank. Muscle Nerve 2022; 66:167-174. [PMID: 35585776 PMCID: PMC9308705 DOI: 10.1002/mus.27635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION/AIMS The amyotrophic lateral sclerosis (ALS) functional rating scale-revised (ALSFRS-R) is commonly used to track ALS disease progression; however, there are gaps in the literature regarding the extent to which the ALSFRS-R relates to underlying central nervous system (CNS) pathology. The current study explored the association between ALSFRS-R (total and subdomain) scores and postmortem neuropathology (both ALS-specific and comorbid disease). METHODS Within our sample of 93 military veterans with autopsy-confirmed ALS, we utilized hierarchical cluster analysis (HCA) to identify discrete profiles of motor dysfunction based on ALSFRS-R subdomain scores. We examined whether emergent clusters were associated with neuropathology. Separate analyses of variance and covariance with post-hoc comparisons were performed to examine relevant cluster differences. RESULTS Analyses revealed significant correlations between ALSFRS-R total and subdomain scores with some, but not all, neuropathological variables. The HCA illustrated three groups: Cluster 1-predominantly diffuse functional impairment; Cluster 2-spared respiratory/bulbar and impaired motor function; and Cluster 3-spared bulbar and impaired respiratory, and fine and gross motor function. Individuals in Cluster 1 (and to a lesser degree, Cluster 3) exhibited greater accumulation of ALS-specific neuropathology and less comorbid neuropathology than those in Cluster 2. DISCUSSION These results suggest that discrete patterns of motor dysfunction based on ALSFRS-R subdomain scores are related to postmortem neuropathology. Findings support use of ALSFRS-R subdomain scores to capture the heterogeneity of clinical presentation and disease progression in ALS, and may assist researchers in identifying endophenotypes for separate assessment in clinical trials.
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Affiliation(s)
| | | | - Thor D. Stein
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Manisha Thakore-James
- VA Boston Healthcare System, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - M. Kian Salajegheh
- VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
- Brigham and Women’s Hospital
| | | | | | | | | | | | | | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, Arizona
| | - Victor E. Alvarez
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
| | - Bertrand R. Huber
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
| | - Ann C. McKee
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Neil W. Kowall
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Department of Neurology, Boston University School of Medicine, Boston, MA
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA
| | - Christopher B. Brady
- VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Harvard Medical School, Boston, MA
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Apreleva Kolomeytseva AT, Brylev L, Eshghi M, Bottaeva Z, Zhang J, Fachner JC, Street AJ. Home-Based Music Therapy to Support Bulbar and Respiratory Functions of Persons with Early and Mid-Stage Amyotrophic Lateral Sclerosis-Protocol and Results from a Feasibility Study. Brain Sci 2022; 12:494. [PMID: 35448025 PMCID: PMC9027911 DOI: 10.3390/brainsci12040494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023] Open
Abstract
Respiratory failure, malnutrition, aspiration pneumonia, and dehydration are the precursors to mortality in ALS. Loss of natural communication is considered one of the worst aspects of ALS. This first study to test the feasibility of a music therapy protocol for bulbar and respiratory rehabilitation in ALS employs a mixed-methods case study series design with repeated measures. Newly diagnosed patients meeting the inclusion criteria were invited to participate, until the desired sample size (n = 8) was achieved. The protocol was delivered to participants in their homes twice weekly for six weeks. Individualised exercise sets for independent practice were provided. Feasibility data (recruitment, retention, adherence, tolerability, self-motivation and personal impressions) were collected. Bulbar and respiratory changes were objectively measured. Results. A high recruitment rate (100%), a high retention rate (87.5%) and high mean adherence to treatment (95.4%) provide evidence for the feasibility of the study protocol. The treatment was well tolerated. Mean adherence to the suggested independent exercise routine was 53%. The outcome measurements to evaluate the therapy-induced change in bulbar and respiratory functions were defined. Findings suggest that the protocol is safe to use in early- and mid-stage ALS and that music therapy was beneficial for the participants' bulbar and respiratory functions. Mean trends suggesting that these functions were sustained or improved during the treatment period were observed for most outcome parameters: Maximal Inspiratory Pressure, Maximal Expiratory Pressure, Peak Expiratory Flow, the Center for Neurologic Study-Bulbar Function Scale speech and swallowing subscales, Maximum Phonation Time, Maximum Repetition Rate-Alternating, Maximum Repetition Rate-Sequential, Jitter, Shimmer, NHR, Speaking rate, Speech-pause ratio, Pause frequency, hypernasality level, Time-to-Laryngeal Vestibule Closure, Maximum Pharyngeal Constriction Area, Peak Position of the Hyoid Bone, Total Pharyngeal Residue C24area. Conclusion. The suggested design and protocol are feasible for a larger study, with some modifications, including aerodynamic measure of nasalance, abbreviated voice sampling and psychological screening.
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Affiliation(s)
| | - Lev Brylev
- Bujanov Moscow City Clinical Hospital, 115419 Moscow, Russia;
- Institute of Higher Nervous Activity and Neurophysiology, 115419 Moscow, Russia
- Moscow Research and Clinical Center for Neuropsychiatry, 115419 Moscow, Russia
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA 02129-4557, USA;
| | - Zhanna Bottaeva
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, 119180 Moscow, Russia;
| | - Jufen Zhang
- Faculty of Health, Education, Medicine & Social Care, School of Medicine, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
| | - Jörg C. Fachner
- Music, Health and the Brain, Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
| | - Alexander J. Street
- Music, Health and the Brain, Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CM1 1SQ, UK;
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Vogelnik K, Koritnik B, Leonardis L, Dolenc Grošelj L, Saifee TA, Zidar J, Kojović M. Shaky hands are a part of motor neuron disease phenotype: clinical and electrophysiological study of 77 patients. J Neurol 2022; 269:4498-4509. [PMID: 35412152 DOI: 10.1007/s00415-022-11096-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the sharp contrast with the existing literature, we frequently observe minipolymyoclonus, tremor and pseudodystonic thumb posturing in patients with motor neuron disease. We conducted a clinical and electrophysiological study to describe phenomenology, prevalence and pathophysiology of involuntary movements in motor neuron disease. METHODS We included 77 consecutive patients. Involuntary movements were assessed at rest and on action. Patients were videotaped. Arm muscle tone, power and deep tendon reflexes were evaluated. Accelerometry with electromyography was recorded in a subset of patients. RESULTS Involuntary movements were observed in 68.9% of patients and could be separated into rest minipolymyoclonus, thumb tremor, pseudodystonic thumb posture, action minipolymyoclonus, and action tremor. One-third of patients reported negative impact of involuntary movements on hand use. Logistic regression showed that rest minipolymyoclonus and thumb tremor were more likely to occur in patients with more prominent distal muscle weakness and less spasticity. Similarly, action involuntary movements were more likely to appear in weaker patients. Patients with brisk tendon reflexes were more likely to display action tremor than action minipolymyoclonus. Action tremor was characterized by accelerometer and corresponding electromyography peak frequency, which decreased with mass loading, suggesting a mechanical-reflex tremor. CONCLUSIONS Involuntary movements are common, but poorly recognized feature of motor neuron disease that may add to functional impairment. Results of our study suggest that involuntary movements are likely of peripheral origin, with a non-fused contraction of enlarged motor units being a common driving mechanism. Minipolymyoclonus appears if no synchronization of motor units occurs. When synchronization occurs via stretch reflex, mechanical-reflex tremor is generated.
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Affiliation(s)
- Katarina Vogelnik
- Division of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.,Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Blaž Koritnik
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Lea Leonardis
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc Grošelj
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tabish A Saifee
- UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Janez Zidar
- Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Kojović
- Division of Neurology, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
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Logan R, Dubel-Haag J, Schcolnicov N, Miller SJ. Novel Genetic Signatures Associated With Sporadic Amyotrophic Lateral Sclerosis. Front Genet 2022; 13:851496. [PMID: 35401706 PMCID: PMC8986983 DOI: 10.3389/fgene.2022.851496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a complex polygenetic neurodegenerative disorder. Establishing a diagnosis for ALS is a challenging and lengthy process. By the time a diagnosis is made, the lifespan prognosis is only about two to 5 years. Genetic testing can be critical in assessing a patient’s risk for ALS, provided they have one of the known familial genes. However, the vast majority of ALS cases are sporadic and have no known associated genetic signatures. Our analysis of the whole genome sequencing data from ALS patients and healthy controls from the Answer ALS Consortium has uncovered twenty-three novel mutations in twenty-two protein-coding genes associated with sporadic ALS cases. The results show the majority of patients with the sporadic form of ALS have at least one or more mutation(s) in the 22 genes we have identified with probabilities of developing ALS ranging from 25–99%, depending on the number of mutations a patient has among the identified genes. Moreover, we have identified a subset of the ALS cohort that has >17 mutations in the 22 identified. In this case, a patient with this mutation profile has a 99% chance of developing ALS and could be classified as being at high risk for the disease. These genetic biomarkers can be used as an early ALS disease diagnostic tool with a rapid and non-invasive technique.
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Affiliation(s)
- Robert Logan
- Pluripotent Diagnostics Corp, Colorado Springs, CO, United States
- Department of Biology, Eastern Nazarene College, Quincy, MA, United States
| | | | | | - Sean J. Miller
- Pluripotent Diagnostics Corp, Colorado Springs, CO, United States
- *Correspondence: Sean J. Miller,
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Al Khleifat A, Iacoangeli A, van Vugt JJFA, Bowles H, Moisse M, Zwamborn RAJ, van der Spek RAA, Shatunov A, Cooper-Knock J, Topp S, Byrne R, Gellera C, López V, Jones AR, Opie-Martin S, Vural A, Campos Y, van Rheenen W, Kenna B, Van Eijk KR, Kenna K, Weber M, Smith B, Fogh I, Silani V, Morrison KE, Dobson R, van Es MA, McLaughlin RL, Vourc'h P, Chio A, Corcia P, de Carvalho M, Gotkine M, Panades MP, Mora JS, Shaw PJ, Landers JE, Glass JD, Shaw CE, Basak N, Hardiman O, Robberecht W, Van Damme P, van den Berg LH, Veldink JH, Al-Chalabi A. Structural variation analysis of 6,500 whole genome sequences in amyotrophic lateral sclerosis. NPJ Genom Med 2022; 7:8. [PMID: 35091648 PMCID: PMC8799638 DOI: 10.1038/s41525-021-00267-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/21/2021] [Indexed: 02/01/2023] Open
Abstract
There is a strong genetic contribution to Amyotrophic lateral sclerosis (ALS) risk, with heritability estimates of up to 60%. Both Mendelian and small effect variants have been identified, but in common with other conditions, such variants only explain a little of the heritability. Genomic structural variation might account for some of this otherwise unexplained heritability. We therefore investigated association between structural variation in a set of 25 ALS genes, and ALS risk and phenotype. As expected, the repeat expansion in the C9orf72 gene was identified as associated with ALS. Two other ALS-associated structural variants were identified: inversion in the VCP gene and insertion in the ERBB4 gene. All three variants were associated both with increased risk of ALS and specific phenotypic patterns of disease expression. More than 70% of people with respiratory onset ALS harboured ERBB4 insertion compared with 25% of the general population, suggesting respiratory onset ALS may be a distinct genetic subtype.
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Affiliation(s)
- Ahmad Al Khleifat
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Alfredo Iacoangeli
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joke J F A van Vugt
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Harry Bowles
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Matthieu Moisse
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology; VIB Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - Ramona A J Zwamborn
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Rick A A van der Spek
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Aleksey Shatunov
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Johnathan Cooper-Knock
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Simon Topp
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Ross Byrne
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Cinzia Gellera
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano and Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Victoria López
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano and Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Ashley R Jones
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Sarah Opie-Martin
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Atay Vural
- Koc University, School of Medicine, Translational Medicine Research Center- NDAL, Istanbul, Turkey
| | - Yolanda Campos
- Mitochondrial pathology Unit, Instituto de Salud Carlos III, Madrid, Spain
| | - Wouter van Rheenen
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Brendan Kenna
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Kristel R Van Eijk
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Kevin Kenna
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Markus Weber
- Neuromuscular Diseases Unit/ALS Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Bradley Smith
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Isabella Fogh
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano and Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Karen E Morrison
- Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Richard Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Michael A van Es
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Russell L McLaughlin
- Complex Trait Genomics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | | | - Adriano Chio
- Rita Levi Montalcini, Department of Neuroscience, ALS Centre, University of Torino, Turin, Italy
- Azienda Ospedaliera Citta della Salute e della Scienza, Torino, Italy
| | - Philippe Corcia
- Centre SLA, CHRU de Tours, Tours, France
- Federation des Centres SLA Tours and Limoges, LITORALS, Tours, France
| | - Mamede de Carvalho
- Physiology Institute, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | | | - Monica P Panades
- Neurology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - John E Landers
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jonathan D Glass
- Department of Neurology, Center for Neurodegenerative Diseases, Emory University, Atlanta, GA, USA
| | - Christopher E Shaw
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK
- King's College Hospital, Denmark Hill, London, UK
| | - Nazli Basak
- Koc University, School of Medicine, Translational Medicine Research Center- NDAL, Istanbul, Turkey
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, Dublin, Republic of Ireland
- Department of Neurology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Wim Robberecht
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology; VIB Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Philip Van Damme
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology; VIB Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Jan H Veldink
- Department of Neurology, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Ammar Al-Chalabi
- King's College London, Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, De Crespigny Park, London, UK.
- King's College Hospital, Denmark Hill, London, UK.
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12
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Verma S, Khurana S, Vats A, Sahu B, Ganguly NK, Chakraborti P, Gourie-Devi M, Taneja V. Neuromuscular Junction Dysfunction in Amyotrophic Lateral Sclerosis. Mol Neurobiol 2022; 59:1502-1527. [PMID: 34997540 DOI: 10.1007/s12035-021-02658-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/18/2021] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurological disorder characterized by progressive degeneration of motor neurons leading to skeletal muscle denervation. Earlier studies have shown that motor neuron degeneration begins in motor cortex and descends to the neuromuscular junction (NMJ) in a dying forward fashion. However, accumulating evidences support that ALS is a distal axonopathy where early pathological changes occur at the NMJ, prior to onset of clinical symptoms and propagates towards the motor neuron cell body supporting "dying back" hypothesis. Despite several evidences, series of events triggering NMJ disassembly in ALS are still obscure. Neuromuscular junction is a specialized tripartite chemical synapse which involves a well-coordinated communication among the presynaptic motor neuron, postsynaptic skeletal muscle, and terminal Schwann cells. This review provides comprehensive insight into the role of NMJ in ALS pathogenesis. We have emphasized the molecular alterations in cellular components of NMJ leading to loss of effective neuromuscular transmission in ALS. Further, we provide a preview into research involved in exploring NMJ as potential target for designing effective therapies for ALS.
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Affiliation(s)
- Sagar Verma
- Department of Research, Sir Ganga Ram Hospital, Delhi, India.,Department of Biotechnology, Jamia Hamdard, Delhi, India
| | - Shiffali Khurana
- Department of Research, Sir Ganga Ram Hospital, Delhi, India.,Department of Biomedical Science, Bhaskaracharya College of Applied Sciences, University of Delhi, Delhi, India
| | - Abhishek Vats
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bandana Sahu
- Department of Research, Sir Ganga Ram Hospital, Delhi, India
| | | | | | | | - Vibha Taneja
- Department of Research, Sir Ganga Ram Hospital, Delhi, India.
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13
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Dalgıç ÖO, Wu H, Safa Erenay F, Sir MY, Özaltın OY, Crum BA, Pasupathy KS. Mapping of critical events in disease progression through binary classification: Application to amyotrophic lateral sclerosis. J Biomed Inform 2021; 123:103895. [PMID: 34450286 DOI: 10.1016/j.jbi.2021.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/05/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The progression of many degenerative diseases is tracked periodically using scales evaluating functionality in daily activities. Although estimating the timing of critical events (i.e., disease tollgates) during degenerative disease progression is desirable, the necessary data may not be readily available in scale records. Further, analysis of disease progression poses data challenges, such as censoring and misclassification errors, which need to be addressed to provide meaningful research findings and inform patients. METHODS We developed a novel binary classification approach to map scale scores into disease tollgates to describe disease progression leveraging standard/modified Kaplan-Meier analyses. The approach is demonstrated by estimating progression pathways in amyotrophic lateral sclerosis (ALS). Tollgate-based ALS Staging System (TASS) specifies the critical events (i.e., tollgates) in ALS progression. We first developed a binary classification predicting whether each TASS tollgate was passed given the itemized ALSFRS-R scores using 514 ALS patients' data from Mayo Clinic-Rochester. Then, we utilized the binary classification to translate/map the ALSFRS-R data of 3,264 patients from the PRO-ACT database into TASS. We derived the time trajectories of ALS progression through tollgates from the augmented PRO-ACT data using Kaplan-Meier analyses. The effects of misclassification errors, condition-dependent dropouts, and censored data in trajectory estimations were evaluated with Interval Censored Kaplan Meier Analysis and Multistate Model for Panel Data. RESULTS The approach using Mayo Clinic data accurately estimated tollgate-passed states of patients given their itemized ALSFRS-R scores (AUCs > 0.90). The tollgate time trajectories derived from the augmented PRO-ACT dataset provide valuable insights; we predicted that the majority of the ALS patients would have modified arm function (67%) and require assistive devices for walking (53%) by the second year after ALS onset. By the third year, most (74%) ALS patients would occasionally use a wheelchair, while 48% of the ALS patients would be wheelchair-dependent by the fourth year. Assistive speech devices and feeding tubes were needed in 49% and 30% of the patients by the third year after ALS onset, respectively. The onset body region alters some tollgate passage time estimations by 1-2 years. CONCLUSIONS The estimated tollgate-based time trajectories inform patients and clinicians about prospective assistive device needs and life changes. More research is needed to personalize these estimations according to prognostic factors. Further, the approach can be leveraged in the progression of other diseases.
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Affiliation(s)
- Özden O Dalgıç
- Harvard Medical School, Boston, MA, USA; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Haoran Wu
- Department of Management Sciences, University of Waterloo, Waterloo, ON, Canada; School of Business, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - F Safa Erenay
- Department of Management Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mustafa Y Sir
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Mayo Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Osman Y Özaltın
- E. P. Fitts Department of Industrial and Systems Engineering, NC State University, Raleigh, NC, USA
| | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kalyan S Pasupathy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Mayo Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
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14
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Toh TH, Abdul-Aziz NA, Yahya MA, Goh KJ, Loh EC, Capelle DP, Shahrizaila N. A model incorporating ultrasound to predict the probability of fast disease progression in amyotrophic lateral sclerosis. Clin Neurophysiol 2021; 132:2722-2728. [PMID: 34312065 DOI: 10.1016/j.clinph.2021.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We aimed to develop a model to predict amyotrophic lateral sclerosis (ALS) disease progression based on clinical and neuromuscular ultrasound (NMUS) parameters. METHODS ALS patients were prospectively recruited. Muscle fasciculation (≥2 over 30-seconds, examined in biceps brachii-brachialis (BB), brachioradialis, tibialis anterior and vastus medialis) and nerve cross-sectional area (CSA) (median, ulnar, tibial, fibular nerve) were evaluated through NMUS. Ultrasound parameters were correlated with clinical data, including revised ALS Functional Rating Scale (ALSFRS-R) progression at one year. A predictive model was constructed to differentiate fast progressors (ALSFRS-R decline ≥ 1/month) from non-fast progressors. RESULTS 40 ALS patients were recruited. Three parameters emerged as strong predictors of fast progressors: (i) ALSFRS-R slope at time of NMUS (p = 0.041), (ii) BB fasciculation count (p = 0.027) and (iii) proximal to distal median nerve CSA ratio < 1.22 (p = 0.026). A predictive model (scores 0-5) was built with excellent discrimination (area under curve: 0.915). Using a score of ≥ 3, the model demonstrated good sensitivity (81.3%) and specificity (91.0%) in differentiating fast from non-fast progressors. CONCLUSION The current model is simple and can predict the probability of fast disease progression. SIGNIFICANCE This model has potential as a surrogate biomarker of ALS disease progression.
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Affiliation(s)
- Tsun-Haw Toh
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Adilah Abdul-Aziz
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Azly Yahya
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean-Jin Goh
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee-Chin Loh
- Palliative Care Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Palliative Care Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Neurology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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15
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Povedano Panades M, Couratier P, Sidle K, Sorarù G, Tsivgoulis G, Ludolph AC. Administration of Riluzole Oral Suspension During the Different Stages of Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:633854. [PMID: 34305774 PMCID: PMC8296145 DOI: 10.3389/fneur.2021.633854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mónica Povedano Panades
- Unitat Funcional de Motoneurona, Neurofisiologia-Servei de Neurologia Hospital Universitario de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain
| | - Philippe Couratier
- Centre de Référence Maladies Rares SLA et Autres Maladies du Neurone Moteur, CHU, Limoges, France
| | - Katie Sidle
- Motor Neuron Disease Association Motor Neuron Disease Care and Research Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Gianni Sorarù
- Department of Neurosciences, University of Padova, Padua, Italy
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National & Kapodistrian University of Athens, Athens, Greece
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16
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Costello E, Rooney J, Pinto-Grau M, Burke T, Elamin M, Bede P, McMackin R, Dukic S, Vajda A, Heverin M, Hardiman O, Pender N. Cognitive reserve in amyotrophic lateral sclerosis (ALS): a population-based longitudinal study. J Neurol Neurosurg Psychiatry 2021; 92:460-465. [PMID: 33563807 DOI: 10.1136/jnnp-2020-324992] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is often associated with cognitive and/or behavioural impairment. Cognitive reserve (CR) may play a protective role in offsetting cognitive impairment. This study examined the relationship between CR and longitudinal change in cognition in an Irish ALS cohort. METHODS Longitudinal neuropsychological assessment was carried out on 189 patients over 16 months using the Edinburgh cognitive and behavioural ALS screen (ECAS) and an additional battery of neuropsychological tests. CR was measured by combining education, occupation and physical activity data. Joint longitudinal and time-to-event models were fitted to investigate the associations between CR, performance at baseline and decline over time while controlling for non-random drop-out. RESULTS CR was a significant predictor of baseline neuropsychological performance, with high CR patients performing better than those with medium or low CR. Better cognitive performance in high CR individuals was maintained longitudinally for ECAS, social cognition, executive functioning and confrontational naming. Patients displayed little cognitive decline over the course of the study, despite controlling for non-random drop-out. CONCLUSIONS These findings suggest that CR plays a role in the presentation of cognitive impairment at diagnosis but is not protective against cognitive decline. However, further research is needed to examine the interaction between CR and other objective correlates of cognitive impairment in ALS.
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Affiliation(s)
- Emmet Costello
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - James Rooney
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Institute and Clinic for Occupational, Social- and Environmental Medicine, University Hospital, Munich, Germany
| | - Marta Pinto-Grau
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Marwa Elamin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Roisin McMackin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Stefan Dukic
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.,Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
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Olsson TT, Svensson M, Hållmarker U, James S, Deierborg T. Delayed Clinical Manifestation of Parkinson's Disease Among Physically Active: Do Participants in a Long-Distance Ski Race Have a Motor Reserve? JOURNAL OF PARKINSONS DISEASE 2021; 10:267-274. [PMID: 31609700 PMCID: PMC7029367 DOI: 10.3233/jpd-191762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Physical activity is associated with reduced risk of Parkinson’s disease (PD). The explanations for this association are not completely elucidated. We use long-term PD-incidence data from long-distance skiers to study the relationship between exercise and PD. Objective: We aimed to investigate if physical activity is associated with long-term lower risk of PD and if this association could be explained by physically active people being able to sustain more PD neuropathology before clinical symptoms, a motor reserve. Methods: Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet (n = 197,685), exhibited reduced incidence of PD compared to matched individuals from the general population (n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5–15 years). Results: Vasaloppet skiers (median age 36.0 years [IQR 29.0–46.0], 38% women) had lower incidence of PD (HR: 0.71; 95 % CI 0.56–0.90) compared to non-skiers. When reducing risk for reverse causation by excluding PD cases within the first five years from race participation, there was still a trend for lower risk of PD (HR: 0.80; 95 % CI 0.62–1.03). Further, the PD prevalence converged between skiers and non-skiers after 15 years of follow-up, which is more consistent with a motor reserve in the physically active rather than neuroprotection. Conclusions: A physical active lifestyle is associated with reduced risk for PD. This association weakens with time and might be explained by a motor reserve among the physically active.
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Affiliation(s)
- Tomas T Olsson
- Department of Neurology, Skåne University Hospital, Lund, Sweden.,Department of Experimental Medical Science, Experimental Dementia Research Unit, Lund University, Lund, Sweden
| | - Martina Svensson
- Department of Experimental Medical Science, Experimental Neuroinflammation Laboratory, Lund University, Lund, Sweden
| | - Ulf Hållmarker
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Department of Internal Medicine, Mora hospital, Mora, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Tomas Deierborg
- Department of Experimental Medical Science, Experimental Neuroinflammation Laboratory, Lund University, Lund, Sweden
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18
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Clinical Determinants of Disease Progression in Amyotrophic Lateral Sclerosis-A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10081623. [PMID: 33921250 PMCID: PMC8069893 DOI: 10.3390/jcm10081623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that is ultimately fatal but characterized by substantial phenotypic heterogeneity, which is known to impact long-term course and survival. This study investigated clinical determinants of disease progression and outcome in a large cohort of patients with ALS. Methods: Retrospective analysis included comprehensive data from 625 patients who attended a tertiary ALS centre at least twice. Patients were stratified according to five distinct clinical phenotypes: classical ALS; bulbar ALS; ALS with frontotemporal dementia (ALS-FTD); upper motor neuron predominant (UMNP); and lower motor neuron predominant (LMNP). Results: This study confirmed higher age at symptom onset, shorter latency to diagnosis and more rapid decline in the revised ALS Functional Rating Scale sum score as predictors of poor prognosis. Hazard ratios for shorter survival were higher in patients with ALS-FTD versus classical ALS, and in patients with versus without chronic obstructive pulmonary disease (COPD). Mean survival was longest in the UMNP phenotype group. Conclusions: This study confirmed established predictors of shorter survival in ALS and showed that concomitant COPD in particular relates to poor outcome.
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19
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Al Khleifat A, Balendra R, Fang T, Al-Chalabi A. Intuitive Staging Correlates With King's Clinical Stage. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:336-340. [PMID: 33821690 DOI: 10.1080/21678421.2020.1867181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Clinical stage in amyotrophic lateral sclerosis (ALS) can be assigned using King's staging with a simple protocol based on the number of CNS regions involved and the presence of significant nutritional or respiratory failure. It is important that the assigned clinical stage matches expectations, and generally corresponds with how a health care professional would intuitively stage the patient. We therefore investigated the relationship between King's clinical ALS stage and ALS stage as intuitively assigned by health care professionals. Methods: We wrote 17 case vignettes describing people with ALS at different disease stages from very early limited disease involvement through to severe, multi-domain disease. During two workshops, we asked health care professionals to intuitively stage the vignettes and compared the answers with the actual King's clinical ALS stage. Results: There was a good correlation between King's clinical ALS stage and intuitively assigned stage, with a Spearman's Rank correlation coefficient of 0.64 (p < 0.001). There was no difference in the intuitive stages assigned by practitioners of different types or at different levels of experience. Conclusions: Across a spectrum of ALS scenarios, King's clinical ALS stage corresponds to intuitive ALS stage as assigned by a range of health care professionals.
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Affiliation(s)
- Ahmad Al Khleifat
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Rubika Balendra
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,Department of Genetics, Evolution and Environment, Institute of Healthy Ageing, University College London, London, UK
| | - Ton Fang
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Department of Neurology, King's College Hospital, London, UK
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20
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Xu L, He B, Zhang Y, Chen L, Fan D, Zhan S, Wang S. Prognostic models for amyotrophic lateral sclerosis: a systematic review. J Neurol 2021; 268:3361-3370. [PMID: 33694050 DOI: 10.1007/s00415-021-10508-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing prognostic models for amyotrophic lateral sclerosis (ALS) have been developed. However, no comprehensive evaluation of these models has been done. The purpose of this study was to map the prognostic models for ALS to assess their potential contribution and suggest future improvements on modeling strategy. METHODS Databases including Medline, Embase, Web of Science, and Cochrane library were searched from inception to 20 February 2021. All studies developing and/or validating prognostic models for ALS were selected. Information regarding modelling method and methodological quality was extracted. RESULTS A total of 28 studies describing the development of 34 models and the external validation of 19 models were included. The outcomes concerned were ALS progression (n = 12; 35%), change in weight (n = 1; 3%), respiratory insufficiency (n = 2; 6%), and survival (n = 19; 56%). Among the models predicting ALS progression or survival, the most frequently used predictors were age, ALS Functional Rating Scale/ALS Functional Rating Scale-Revised, site of onset, and disease duration. The modelling method adopted most was machine learning (n = 16; 47%). Most of the models (n = 25; 74%) were not presented. Discrimination and calibration were assessed in 12 (35%) and 2 (6%) models, respectively. Only one model by Westeneng et al. (Lancet Neurol 17:423-433, 2018) was assessed with overall low risk of bias and it performed well in both discrimination and calibration, suggesting a relatively reliable model for practice. CONCLUSIONS This study systematically reviewed the prognostic models for ALS. Their usefulness is questionable due to several methodological pitfalls and the lack of external validation done by fully independent researchers. Future research should pay more attention to the addition of novel promising predictors, external validation, and head-to-head comparisons of existing models.
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Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Bingjie He
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yunjing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Lu Chen
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China. .,Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. .,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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21
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Comorbidity Pattern Analysis for Predicting Amyotrophic Lateral Sclerosis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Electronic Medical Records (EMRs) can be used to create alerts for clinicians to identify patients at risk and to provide useful information for clinical decision-making support. In this study, we proposed a novel approach for predicting Amyotrophic Lateral Sclerosis (ALS) based on comorbidities and associated indicators using EMRs. The medical histories of ALS patients were analyzed and compared with those of subjects without ALS, and the associated comorbidities were selected as features for constructing the machine learning and prediction model. We proposed a novel weighted Jaccard index (WJI) that incorporates four different machine learning techniques to construct prediction systems. Alternative prediction models were constructed based on two different levels of comorbidity: single disease codes and clustered disease codes. With an accuracy of 83.7%, sensitivity of 78.8%, specificity of 85.7%, and area under the receiver operating characteristic curve (AUC) value of 0.907 for the single disease code level, the proposed WJI outperformed the traditional Jaccard index (JI) and scoring methods. Incorporating the proposed WJI into EMRs enabled the construction of a prediction system for analyzing the risk of suffering a specific disease based on comorbidity combinatorial patterns, which could provide a fast, low-cost, and noninvasive evaluation approach for early diagnosis of a specific disease.
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22
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The effectiveness of nonsteroidal anti-inflammatory drugs and acetaminophen in reduce the risk of amyotrophic lateral sclerosis? A meta-analysis. Sci Rep 2020; 10:14759. [PMID: 32901053 PMCID: PMC7479139 DOI: 10.1038/s41598-020-71813-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022] Open
Abstract
To test the hypothesis that aspirin, non-aspirin nonsteroidal anti-infammatory drugs (NA-NSAIDs), or acetaminophen can reduce the risk of ALS, we conducted a systematic review and meta-analysis of related previous studies. A comprehensive search was conducted on the PubMed, Embase, Cochrane Library and SCOPUS databases. It included studies published up to 29 February 2020 that fulfilled our inclusion criteria. Aspirin, acetaminophen and NA-NSAIDs use information, between the ALS and control groups, was collected for the meta-analysis. Rates of aspirin, NA-NSAID, and acetaminophen use in ALS group, compared with control group were investigated. In the results, only three studies that relate the risk of ALS to aspirin, NA-NSAIDs and acetaminophen use satisfied the inclusion criteria for the meta-analysis. Regarding aspirin, the studies did not show any statistically significant difference in aspirin use between the ALS and control groups (Odds ratio, 1.04 [95% confidence interval, 0.90–1.21]). NA-NSAIDs and acetaminophen use, however, did show up statistically significant differences in between the ALS and control groups. (Odds ratio, 0.82 [95% confidence interval, 0.73–0.91]) and (Odds ratio, 0.80 [95% confidence interval, 0.69–0.93]). However, our study has some limitations. Firstly, we only included a small number of studies. Secondly, the included studies did not control for past medical history, which may have confounded their results, and in turn, could have caused bias in our study. Thirdly, in this meta-analysis, the ALS patients were not subdivided into sporadic or familial type. Lastly, the studies also did not consider the types of NSAIDs and dosages used of each drug. For more convincing evidence regarding the effectiveness of aspirin, NA-NSAIDs and acetaminophen to reduce the risk of ALS occurrence, more qualified prospective studies are required. In conclusion, the use of NA-NSAIDs and acetaminophen is associated with a decreased risk for the development of ALS. In contrast, aspirin did not have any effect on the reduction of the risk of ALS occurrence.
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23
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McCombe PA, Garton FC, Katz M, Wray NR, Henderson RD. What do we know about the variability in survival of patients with amyotrophic lateral sclerosis? Expert Rev Neurother 2020; 20:921-941. [PMID: 32569484 DOI: 10.1080/14737175.2020.1785873] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION ALS is a fatal neurodegenerative disease. However, patients show variability in the length of survival after symptom onset. Understanding the mechanisms of long survival could lead to possible avenues for therapy. AREAS COVERED This review surveys the reported length of survival in ALS, the clinical features that predict survival in individual patients, and possible factors, particularly genetic factors, that could cause short or long survival. The authors also speculate on possible mechanisms. EXPERT OPINION a small number of known factors can explain some variability in ALS survival. However, other disease-modifying factors likely exist. Factors that alter motor neurone vulnerability and immune, metabolic, and muscle function could affect survival by modulating the disease process. Knowing these factors could lead to interventions to change the course of the disease. The authors suggest a broad approach is needed to quantify the proportion of variation survival attributable to genetic and non-genetic factors and to identify and estimate the effect size of specific factors. Studies of this nature could not only identify novel avenues for therapeutic research but also play an important role in clinical trial design and personalized medicine.
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Affiliation(s)
- Pamela A McCombe
- Centre for Clinical Research, The University of Queensland , Brisbane, Australia.,Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane, Australia
| | - Fleur C Garton
- Institute for Molecular Biosciences, The University of Queensland , Brisbane, Australia
| | - Matthew Katz
- Department of Neurology, Royal Brisbane and Women's Hospital , Brisbane, Australia
| | - Naomi R Wray
- Institute for Molecular Biosciences, The University of Queensland , Brisbane, Australia.,Queensland Brain Institute, The University of Queensland , Brisbane, Australia
| | - Robert D Henderson
- Centre for Clinical Research, The University of Queensland , Brisbane, Australia
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24
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Minimizing the Diagnostic Delay in Amyotrophic Lateral Sclerosis: The Role of Nonneurologist Practitioners. Neurol Res Int 2020; 2020:1473981. [PMID: 32455015 PMCID: PMC7238340 DOI: 10.1155/2020/1473981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS), usually fatal in a few years, is a neurodegenerative disorder where the diagnostic delay, although variable according to the studies, remains too long. The main objective of this study was to determine the average time to diagnose ALS and the role of each physician, general practitioner (GP), or specialist (neurologist or not) involved in the management of these patients. The secondary objective was to propose some simple schemes to quickly identify an ALS suspicion with the aim to reduce this delay. Patients and Methods. This retrospective study evaluated the diagnostic delay (and other intermediate delays) of 90 ALS patients registered in the ALS Center of Bordeaux (France) in 2013. The main clinical signs encountered (and their order of appearance) were studied. Results The average diagnostic delay was 17 months, with a median diagnostic delay of 12 months. The average diagnostic delay was 2.7 months between the first symptoms and the first complaint to GP, followed by an additional 6.5 month delay before the patient's first visit to a neurologist. This period could be shortened, especially if GP performed additional tests quickly (p=0.01), as the time spent consulting various specialists often extends this crucial step. Overall, diagnostic delay accounted for 40% of the total duration of the disease progression. Conclusion In relation to total survival time, the diagnostic delay of ALS appears to be proportionately very long, sometimes longer than that observed in previous studies (because it also included the total delay to diagnostic or treatment initiation). The rapid execution of useful additional tests by the first medical doctor, often GP (with the help of a neurologist), considerably reduces the diagnostic delay. The central role of GP seems to be crucial in the management of patients with ALS. The main objective is, of course, to initiate appropriate treatment and care as soon as possible. Finally, based on our results, we also provide a short practical diagram to help nonneurologist practitioners to quickly discuss the diagnosis of ALS in case of some specific symptoms (“red flags”).
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25
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Falzone YM, Domi T, Agosta F, Pozzi L, Schito P, Fazio R, Del Carro U, Barbieri A, Comola M, Leocani L, Comi G, Carrera P, Filippi M, Quattrini A, Riva N. Serum phosphorylated neurofilament heavy-chain levels reflect phenotypic heterogeneity and are an independent predictor of survival in motor neuron disease. J Neurol 2020; 267:2272-2280. [PMID: 32306171 PMCID: PMC7166001 DOI: 10.1007/s00415-020-09838-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
To investigate the prognostic role and the major determinants of serum phosphorylated neurofilament heavy -chain (pNfH) concentration across a large cohort of motor neuron disease (MND) phenotypes. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum pNfH concentration in 219 MND patients consecutively enrolled in our tertiary MND clinic. A multifactorial analysis was carried out to investigate the major clinical determinants of serum pNfH. Kaplan–Meier survival curves and Cox regression analysis were performed to explore the prognostic value of serum pNfH. Serum pNfH levels were not homogenous among MND phenotypes; higher concentrations in pyramidal, bulbar, and classic phenotypes were observed. C9orf72-MND exhibited higher pNfH concentrations compared to non-C9orf72 MND. Multiple linear regression analysis revealed mean MEP/cMAP and disease progression rate as the two major predictors of serum pNfH levels (R2 = 0.188; p ≤ 0.001). Kaplan–Meier curves showed a significant difference of survival among MND subgroups when divided into quartiles based on pNfH concentrations, log-rank X2 = 53.0, p ≤ 0.0001. Our study evidenced that higher serum pNfH concentration is a negative independent prognostic factor for survival. In Cox multivariate model, pNfH concentration showed the highest hazard ratio compared to the other factors influencing survival included in the analysis. pNfH differs among the MND phenotypes and is an independent prognostic factor for survival. This study provides supporting evidence of the role of pNfH as useful prognostic biomarker for MND patients. Neurofilament measurements should be considered in the future prognostic models and in clinical trials for biomarker-based stratification, and to evaluate treatment response.
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Affiliation(s)
- Yuri Matteo Falzone
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Teuta Domi
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Paride Schito
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Fazio
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Neurophysiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Barbieri
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Mauro Comola
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Letizia Leocani
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Paola Carrera
- Division of Genetics and Cell Biology, Unit of Genomics for Human Disease Diagnosis, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Neuroimaging Research Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Division of Neuroscience, Neuropathology Unit, San Raffaele Scientific Institute, via Olgettina 48, 20132, Milan, Italy.
- Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy.
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26
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Klavžar P, Koritnik B, Leonardis L, Dolenc Grošelj L, Kirbiš M, Ristić Kovačič S, Klinar P, Pohar Perme M, Zidar J. Improvements in the multidisciplinary care are beneficial for survival in amyotrophic lateral sclerosis (ALS): experience from a tertiary ALS center. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:203-208. [PMID: 32248716 DOI: 10.1080/21678421.2020.1746809] [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: 10/24/2022]
Abstract
Objective: The Ljubljana ALS Centre, established in 2002, is the only tertiary center for amyotrophic lateral sclerosis (ALS) in Slovenia. The aim of our study was to evaluate the impact of therapeutic interventions and improvements in the multidisciplinary care on the survival of our patients.Methods: All patients diagnosed with ALS at our center during years 2003-2005 (early group) and 2011-2012 (late group) were included in this retrospective cohort study (n = 124). Kaplan-Meier survival analysis and multiple regression analysis with Cox proportional hazards model were performed to compare survival and to evaluate the differences between the two cohorts.Results: Median survival from the time of diagnosis was 13.0 (95% CI 10.2-15.8) months in the early group and 21.8 (95% CI 17.2-26.4) months in the late group (p = 0.005). In the Cox proportional hazards analysis, the late group of patients was associated with better survival independently of all other prognostic factors (hazard ratio (HR)=0.51, 95% CI = 0.32-0.81, p = 0.004). Survival was also associated with patients' age, use of noninvasive ventilation (NIV) and gastrostomy. The model fit significantly improved when the interaction between the NIV use and the observed time period was added to the model (HR = 0.34, 95% CI = 0.12-0.96, p = 0.041).Conclusions: Our findings suggest that improvements in the multidisciplinary care were beneficial for survival of our patients with ALS. The survival benefit in the late group of our patients could be partially explained by the improvements in the NIV use at our center.
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Affiliation(s)
- Polona Klavžar
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Blaž Koritnik
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lea Leonardis
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Leja Dolenc Grošelj
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Kirbiš
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Stanka Ristić Kovačič
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Polona Klinar
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Pohar Perme
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Zidar
- Ljubljana ALS Centre, Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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27
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Crown A, McAlary L, Fagerli E, Brown H, Yerbury JJ, Galaleldeen A, Cashman NR, Borchelt DR, Ayers JI. Tryptophan residue 32 in human Cu-Zn superoxide dismutase modulates prion-like propagation and strain selection. PLoS One 2020; 15:e0227655. [PMID: 31999698 PMCID: PMC6991973 DOI: 10.1371/journal.pone.0227655] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/21/2019] [Indexed: 12/14/2022] Open
Abstract
Mutations in Cu/Zn superoxide dismutase 1 (SOD1) associated with familial amyotrophic lateral sclerosis cause the protein to aggregate via a prion-like process in which soluble molecules are recruited to aggregates by conformational templating. These misfolded SOD1 proteins can propagate aggregation-inducing conformations across cellular membranes. Prior studies demonstrated that mutation of a Trp (W) residue at position 32 to Ser (S) suppresses the propagation of misfolded conformations between cells, whereas other studies have shown that mutation of Trp 32 to Phe (F), or Cys 111 to Ser, can act in cis to attenuate aggregation of mutant SOD1. By expressing mutant SOD1 fused with yellow fluorescent protein (YFP), we compared the relative ability of these mutations to modulate the formation of inclusions by ALS-mutant SOD1 (G93A and G85R). Only mutation of Trp 32 to Ser persistently reduced the formation of the amorphous inclusions that form in these cells, consistent with the idea that a Ser at position 32 inhibits templated propagation of aggregation prone conformations. To further test this idea, we produced aggregated fibrils of recombinant SOD1-W32S in vitro and injected them into the spinal cords of newborn mice expressing G85R-SOD1: YFP. The injected mice developed an earlier onset paralysis with a frequency similar to mice injected with WT SOD1 fibrils, generating a strain of misfolded SOD1 that produced highly fibrillar inclusion pathology. These findings suggest that the effect of Trp 32 in modulating the propagation of misfolded SOD1 conformations may be dependent upon the “strain” of the conformer that is propagating.
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Affiliation(s)
- Anthony Crown
- Center for Translational Research in Neurodegenerative Disease, SantaFe HealthCare Alzheimer’s Disease Research Center, Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
| | - Luke McAlary
- Molecular Horizons and School of Chemistry & Molecular Bioscience, University of Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, School of Chemistry & Molecular Bioscience, University of Wollongong, New South Wales, Australia
| | - Eric Fagerli
- Center for Translational Research in Neurodegenerative Disease, SantaFe HealthCare Alzheimer’s Disease Research Center, Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
| | - Hilda Brown
- Center for Translational Research in Neurodegenerative Disease, SantaFe HealthCare Alzheimer’s Disease Research Center, Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
| | - Justin J. Yerbury
- Molecular Horizons and School of Chemistry & Molecular Bioscience, University of Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, School of Chemistry & Molecular Bioscience, University of Wollongong, New South Wales, Australia
| | - Ahmad Galaleldeen
- Department of Biological Sciences, St. Mary’s University, San Antonio, Texas, United States of America
| | - Neil R. Cashman
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R. Borchelt
- Center for Translational Research in Neurodegenerative Disease, SantaFe HealthCare Alzheimer’s Disease Research Center, Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
| | - Jacob I. Ayers
- Center for Translational Research in Neurodegenerative Disease, SantaFe HealthCare Alzheimer’s Disease Research Center, Department of Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
- Institute for Neurodegenerative Disease, University of California, San Francisco, California, United States of America
- * E-mail:
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28
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van Eijk RPA, Nikolakopoulos S, Roes KCB, Middelkoop BM, Ferguson TA, Shaw PJ, Leigh PN, Al-Chalabi A, Eijkemans MJC, van den Berg LH. Critical design considerations for time-to-event endpoints in amyotrophic lateral sclerosis clinical trials. J Neurol Neurosurg Psychiatry 2019; 90:1331-1337. [PMID: 31292200 PMCID: PMC6902062 DOI: 10.1136/jnnp-2019-320998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Funding and resources for low prevalent neurodegenerative disorders such as amyotrophic lateral sclerosis (ALS) are limited, and optimising their use is vital for efficient drug development. In this study, we review the design assumptions for pivotal ALS clinical trials with time-to-event endpoints and provide optimised settings for future trials. METHODS We extracted design settings from 13 completed placebo-controlled trials. Optimal assumptions were estimated using parametric survival models in individual participant data (n=4991). Designs were compared in terms of sample size, trial duration, drug use and costs. RESULTS Previous trials overestimated the hazard rate by 18.9% (95% CI 3.4% to 34.5%, p=0.021). The median expected HR was 0.56 (range 0.33-0.66). Additionally, we found evidence for an increasing mean hazard rate over time (Weibull shape parameter of 2.03, 95% CI 1.93 to 2.15, p<0.001), which affects the design and planning of future clinical trials. Incorporating accrual time and assuming an increasing hazard rate at the design stage reduced sample size by 33.2% (95% CI 27.9 to 39.4), trial duration by 17.4% (95% CI 11.6 to 23.3), drug use by 14.3% (95% CI 9.6 to 19.0) and follow-up costs by 21.2% (95% CI 15.6 to 26.8). CONCLUSIONS Implementing distributional knowledge and incorporating accrual at the design stage could achieve large gains in the efficiency of ALS clinical trials with time-to-event endpoints. We provide an open-source platform that helps investigators to make more accurate sample size calculations and optimise the use of their available resources.
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Affiliation(s)
- Ruben P A van Eijk
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands .,Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Stavros Nikolakopoulos
- Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Kit C B Roes
- Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Bas M Middelkoop
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Toby A Ferguson
- Department of Neurology Research and Early Clinical Development, Biogen Inc, Cambridge, Massachusetts, USA
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - P Nigel Leigh
- Department of Clinical Neuroscience, Trafford Centre for Biomedical Research, Brighton and Sussex Medical School, Brighton, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Marinus J C Eijkemans
- Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
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29
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Deora V, Lee JD, Albornoz EA, McAlary L, Jagaraj CJ, Robertson AAB, Atkin JD, Cooper MA, Schroder K, Yerbury JJ, Gordon R, Woodruff TM. The microglial NLRP3 inflammasome is activated by amyotrophic lateral sclerosis proteins. Glia 2019; 68:407-421. [DOI: 10.1002/glia.23728] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 08/15/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Vandana Deora
- School of Biomedical Sciences, Faculty of Medicine The University of Queensland St. Lucia Queensland Australia
| | - John D. Lee
- School of Biomedical Sciences, Faculty of Medicine The University of Queensland St. Lucia Queensland Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine The University of Queensland Herston Queensland Australia
| | - Eduardo A. Albornoz
- School of Biomedical Sciences, Faculty of Medicine The University of Queensland St. Lucia Queensland Australia
- Institute for Molecular Bioscience, and Centre for Inflammation and Disease Research The University of Queensland St. Lucia Queensland Australia
| | - Luke McAlary
- School of Chemistry and Molecular Biosciences, Faculty of Science, Medicine and Health University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Institute University of Wollongong Wollongong New South Wales Australia
| | - Cyril J. Jagaraj
- Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Centre for MND Research Macquarie University New South Wales Australia
| | - Avril A. B. Robertson
- Institute for Molecular Bioscience, and Centre for Inflammation and Disease Research The University of Queensland St. Lucia Queensland Australia
- School of Chemistry and Molecular Biosciences The University of Queensland St. Lucia Queensland Australia
| | - Julie D. Atkin
- Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Centre for MND Research Macquarie University New South Wales Australia
| | - Matthew A. Cooper
- Institute for Molecular Bioscience, and Centre for Inflammation and Disease Research The University of Queensland St. Lucia Queensland Australia
| | - Kate Schroder
- Institute for Molecular Bioscience, and Centre for Inflammation and Disease Research The University of Queensland St. Lucia Queensland Australia
| | - Justin J. Yerbury
- School of Chemistry and Molecular Biosciences, Faculty of Science, Medicine and Health University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Institute University of Wollongong Wollongong New South Wales Australia
| | - Richard Gordon
- School of Biomedical Sciences, Faculty of Medicine The University of Queensland St. Lucia Queensland Australia
- University of Queensland Centre for Clinical Research, Faculty of Medicine The University of Queensland Herston Queensland Australia
| | - Trent M. Woodruff
- School of Biomedical Sciences, Faculty of Medicine The University of Queensland St. Lucia Queensland Australia
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Influence of Lineage-Negative Stem Cell Therapy on Articulatory Functions in ALS Patients. Stem Cells Int 2019; 2019:7213854. [PMID: 31281384 PMCID: PMC6589318 DOI: 10.1155/2019/7213854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Amyotrophic lateral sclerosis (ALS) is a fatal, neurodegenerative disease, leading to loss of muscle strength and motor control. Impaired speech and swallowing lower the quality of life and consequently may induce acute respiratory failure. Bone marrow-derived stem and progenitor cells (SPCs) may be a valuable source of trophic factors. In this study, we assessed whether adjuvant cellular therapy could affect the levels of selected neurotrophins and proinflammatory factors in the cerebrospinal fluid (CSF) and subsequently prevent the deterioration of articulation. Materials and Methods The study group consisted of 32 patients with sporadic ALS who underwent autologous lineage-negative (Lin−) stem cell intrathecal administration to the spinal canal. Lin− cells were aspirated from the bone marrow and isolated using immunomagnetic beads and a lineage cell depletion kit. Patients were examined for articulatory functions by means of the Voice Handicap Index (VHI) questionnaire and Frenchay Dysarthria Assessment (FDA). In parallel, we carried out the analysis of selected trophic and proinflammatory factors in CSF utilizing multiplex fluorescent bead-based immunoassays. Results Of the 32 patients who received the Lin− progenitor cell therapy, 6 (group I) showed improvement in articulatory functions, 23 remained stable (group II), and 3 deteriorated (group III) on the 28th day. The improvement was particularly noticeable in a better cough reflex, laryngeal time, and dribble reflex. A statistically significant lower level of brain-derived neurotrophic factor (BDNF) was observed on day 0 in group I compared to group II. The CSF concentrations of C-reactive protein (CRP) in group I significantly decreased 7 days after Lin− SPC transplantation. On the contrary, a significant increase in the tumor necrosis factor receptor (TNF-R) level was confirmed among patients from group I with improvement of dribble and coughing reflex, tongue movements, and respiration on the 7th day, as well as on day 28 including dribble reflex solely. Conclusions An application of Lin− stem cells could potentate the beneficial humoral effect. The prevention of deterioration of articulatory functions in ALS patients after applying adjuvant Lin− stem cell therapy seems to be promising. Although the procedure is safe and feasible, it requires further in-depth studies.
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Agosta F, Spinelli EG, Riva N, Fontana A, Basaia S, Canu E, Castelnovo V, Falzone Y, Carrera P, Comi G, Filippi M. Survival prediction models in motor neuron disease. Eur J Neurol 2019; 26:1143-1152. [PMID: 30920076 DOI: 10.1111/ene.13957] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to assess the predictive value of multimodal brain magnetic resonance imaging (MRI) on survival in a large cohort of patients with motor neuron disease (MND), in combination with clinical and cognitive features. METHODS Two hundred MND patients were followed up prospectively for a median of 4.13 years. At baseline, subjects underwent neurological examination, cognitive assessment and brain MRI. Grey matter volumes of cortical and subcortical structures and diffusion tensor MRI metrics of white matter tracts were obtained. A multivariable Royston-Parmar survival model was created using clinical and cognitive variables. The increase of survival prediction accuracy provided by MRI variables was assessed. RESULTS The multivariable clinical model included predominant upper or lower motor neuron presentations and diagnostic delay as significant prognostic predictors, reaching an area under the receiver operating characteristic curve (AUC) of a 4-year survival prediction of 0.79. The combined clinical and MRI model including selected grey matter fronto-temporal volumes and diffusion tensor MRI metrics of the corticospinal and extra-motor tracts reached an AUC of 0.89. Considering amyotrophic lateral sclerosis patients only, the clinical model including diagnostic delay and semantic fluency scores provided an AUC of 0.62, whereas the combined clinical and MRI model reached an AUC of 0.77. CONCLUSION Our study demonstrated that brain MRI measures of motor and extra-motor structural damage, when combined with clinical and cognitive features, are useful predictors of survival in patients with MND, particularly when a diagnosis of amyotrophic lateral sclerosis is made.
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Affiliation(s)
- F Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - E G Spinelli
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - N Riva
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - A Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - S Basaia
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - E Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - V Castelnovo
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Y Falzone
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - P Carrera
- Unit of Genomics for Human Disease Diagnosis, Division of Genetics and Cell Biology, Clinical Molecular Biology Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - G Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Lechtzin N. Predicting respiratory failure in amyotrophic lateral sclerosis: recruiting a few good pulmonologists. Eur Respir J 2019; 53:53/4/1900360. [PMID: 31000666 DOI: 10.1183/13993003.00360-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/03/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Noah Lechtzin
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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33
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Jun KY, Park J, Oh KW, Kim EM, Bae JS, Kim I, Kim SH. Epidemiology of ALS in Korea using nationwide big data. J Neurol Neurosurg Psychiatry 2019; 90:395-403. [PMID: 30409890 PMCID: PMC6581156 DOI: 10.1136/jnnp-2018-318974] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine the incidence, prevalence and survival time of Korean patients with amyotrophic lateral sclerosis (ALS) using National Health Insurance Service (NHIS) data. METHODS Using NHIS data, the Korean nationwide health dataset, we identified patients with motor neuron diseases who were first diagnosed with a KCD-6 code (G12.20-G12.28; modified from ICD-10 codes) between 2011 and 2015. ALS (G12.21 code) epidemiological characteristics, including annual incidence, prevalence, mortality rates and survival time, were analysed and compared with sociodemographic variables. RESULTS New patients with ALS (n=3049) were enrolled over 5 years. The mean annual incidence was 1.20/100 000, and the sex ratio was 1.60 (male:female). The mean age at the time of diagnosis was 61.4 years. The prevalence rate was 3.43/100 000 in 2015. In this period, riluzole was prescribed to 53.6% of patients with ALS. Furthermore, 20.3% of patients with ALS underwent tracheostomy. When analysed for age and socioeconomic status, ALS prevalence rate was 10.71 in the aged group (≥60) in 2015 and was lowest in the middle-income group compared with that in the high-income and low-income groups. The estimated mean survival time in this population was 50.0 months, and the 3-year and 5-year mortality rates were 52.1% and 63.7%, respectively. CONCLUSIONS This study is the first nationwide survey for epidemiological characteristics of ALS in Korea using national data. The use of these data substantially advances the understanding of Korean and Asian ALS epidemiology and its relationship with socioeconomic status, age and sex.
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Affiliation(s)
- Kyo Yeon Jun
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea.,Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
| | - Eun Mi Kim
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Inah Kim
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Republic of Korea .,Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea .,Cell Therapy Center, Hanyang University, Seoul, Republic of Korea
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Schreiber S, Schreiber F, Garz C, Debska‐Vielhaber G, Assmann A, Perosa V, Petri S, Dengler R, Nestor P, Vielhaber S. Toward
in vivo
determination of peripheral nervous system immune activity in amyotrophic lateral sclerosis. Muscle Nerve 2019; 59:567-576. [DOI: 10.1002/mus.26444] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Stefanie Schreiber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Frank Schreiber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Cornelia Garz
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Grazyna Debska‐Vielhaber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
| | - Anne Assmann
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Valentina Perosa
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
| | - Susanne Petri
- Department of NeurologyHannover Medical School Hannover Germany
| | | | - Peter Nestor
- Queensland Brain InstituteUniversity of Queensland Brisbane Queensland Australia
| | - Stefan Vielhaber
- Department of NeurologyOtto‐von‐Guericke University Leipziger Straße 44, 39120 Magdeburg Germany
- German Center for Neurodegenerative Diseases within the Helmholtz Association Magdeburg Germany
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Grollemund V, Pradat PF, Querin G, Delbot F, Le Chat G, Pradat-Peyre JF, Bede P. Machine Learning in Amyotrophic Lateral Sclerosis: Achievements, Pitfalls, and Future Directions. Front Neurosci 2019; 13:135. [PMID: 30872992 PMCID: PMC6403867 DOI: 10.3389/fnins.2019.00135] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Amyotrophic Lateral Sclerosis (ALS) is a relentlessly progressive neurodegenerative condition with limited therapeutic options at present. Survival from symptom onset ranges from 3 to 5 years depending on genetic, demographic, and phenotypic factors. Despite tireless research efforts, the core etiology of the disease remains elusive and drug development efforts are confounded by the lack of accurate monitoring markers. Disease heterogeneity, late-stage recruitment into pharmaceutical trials, and inclusion of phenotypically admixed patient cohorts are some of the key barriers to successful clinical trials. Machine Learning (ML) models and large international data sets offer unprecedented opportunities to appraise candidate diagnostic, monitoring, and prognostic markers. Accurate patient stratification into well-defined prognostic categories is another aspiration of emerging classification and staging systems. Methods: The objective of this paper is the comprehensive, systematic, and critical review of ML initiatives in ALS to date and their potential in research, clinical, and pharmacological applications. The focus of this review is to provide a dual, clinical-mathematical perspective on recent advances and future directions of the field. Another objective of the paper is the frank discussion of the pitfalls and drawbacks of specific models, highlighting the shortcomings of existing studies and to provide methodological recommendations for future study designs. Results: Despite considerable sample size limitations, ML techniques have already been successfully applied to ALS data sets and a number of promising diagnosis models have been proposed. Prognostic models have been tested using core clinical variables, biological, and neuroimaging data. These models also offer patient stratification opportunities for future clinical trials. Despite the enormous potential of ML in ALS research, statistical assumptions are often violated, the choice of specific statistical models is seldom justified, and the constraints of ML models are rarely enunciated. Conclusions: From a mathematical perspective, the main barrier to the development of validated diagnostic, prognostic, and monitoring indicators stem from limited sample sizes. The combination of multiple clinical, biofluid, and imaging biomarkers is likely to increase the accuracy of mathematical modeling and contribute to optimized clinical trial designs.
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Affiliation(s)
- Vincent Grollemund
- Laboratoire d'Informatique de Paris 6, Sorbonne University, Paris, France
- FRS Consulting, Paris, France
| | - Pierre-François Pradat
- Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Sorbonne Université, Paris, France
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre Référent SLA, Paris, France
- Northern Ireland Center for Stratified Medecine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Londonderry, United Kingdom
| | - Giorgia Querin
- Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Sorbonne Université, Paris, France
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre Référent SLA, Paris, France
| | - François Delbot
- Laboratoire d'Informatique de Paris 6, Sorbonne University, Paris, France
- Département de Mathématiques et Informatique, Paris Nanterre University, Nanterre, France
| | | | - Jean-François Pradat-Peyre
- Laboratoire d'Informatique de Paris 6, Sorbonne University, Paris, France
- Département de Mathématiques et Informatique, Paris Nanterre University, Nanterre, France
- Modal'X, Paris Nanterre University, Nanterre, France
| | - Peter Bede
- Laboratoire d'Imagerie Biomédicale, INSERM, CNRS, Sorbonne Université, Paris, France
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre Référent SLA, Paris, France
- Computational Neuroimaging Group, Trinity College, Dublin, Ireland
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36
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Miltenberger-Miltenyi G, Conceição VA, Gromicho M, Pronto-Laborinho AC, Pinto S, Andersen PM, de Carvalho M. C9orf72 expansion is associated with accelerated decline of respiratory function and decreased survival in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:118-120. [PMID: 29661924 DOI: 10.1136/jnnp-2018-318032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/16/2018] [Accepted: 03/28/2018] [Indexed: 12/14/2022]
Affiliation(s)
| | - Vasco A Conceição
- Physiology Institute, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Marta Gromicho
- Physiology Institute, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | | | - Susana Pinto
- Physiology Institute, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Peter M Andersen
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Mamede de Carvalho
- Physiology Institute, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal
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37
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Pawlitzki M, Schreiber S, Bittner D, Kreipe J, Leypoldt F, Rupprecht K, Carare RO, Meuth SG, Vielhaber S, Körtvélyessy P. CSF Neurofilament Light Chain Levels in Primary Progressive MS: Signs of Axonal Neurodegeneration. Front Neurol 2018; 9:1037. [PMID: 30631300 PMCID: PMC6315185 DOI: 10.3389/fneur.2018.01037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives: Elevated neurofilament light chain (NFL) levels within the cerebrospinal fluid (CSF) are a biomarker representing axonal neurodegeneration in rapid progressive neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS). It is unclear to what extent the levels of NFL increase in the CSF (CSF-NFL) in a chronic neuroinflammatory process with axonal neurodegeneration, as found in primary progressive multiple sclerosis (PPMS). Methods: We used a multicenter approach to statistically compare CSF-NFL levels between PPMS patients (n = 50), ALS patients (n = 50), and healthy controls (n = 50). Clinical findings, including disease duration, expanded disability status scale (EDSS), electrophysiological recordings such as visual evoked potentials or spinal and cerebral MRI, and previously administered treatment were selected as experimental parameters retrospectively. Results: Median [range] CSF-NFL concentrations in PPMS patients were significantly higher than in the controls [1724 (799–4275) pg/ml vs. 1202 (612–2934) pg/ml, p = 0.015], and significantly lower compared to ALS patients [1724 (799–4275) pg/ml vs. 10238 (2610–35138) pg/ml, p < 0.001]. There was no correlation between CSF-NFL and disease duration (p = 0.5), EDSS (p = 0.2) or treatment (p = 0.3). Conclusion: We conclude that CSF-NFL may mirror the proposed slow axonal degeneration in PPMS, but does not reflect the disease severity.
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Affiliation(s)
- Marc Pawlitzki
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Münster, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Daniel Bittner
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Julia Kreipe
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Klemens Rupprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Münster, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Peter Körtvélyessy
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
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38
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Crosby K, Crown AM, Roberts BL, Brown H, Ayers JI, Borchelt DR. Loss of charge mutations in solvent exposed Lys residues of superoxide dismutase 1 do not induce inclusion formation in cultured cell models. PLoS One 2018; 13:e0206751. [PMID: 30399166 PMCID: PMC6219784 DOI: 10.1371/journal.pone.0206751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/18/2018] [Indexed: 12/14/2022] Open
Abstract
Mutations in superoxide dismutase 1 (SOD1) associated with familial amyotrophic lateral sclerosis (fALS) induce the protein to misfold and aggregate. Missense mutations at more than 80 different amino acid positions have been associated with disease. How these mutations heighten the propensity of SOD1 to misfold and aggregate is unclear. With so many mutations, it is possible that more than one mechanism of aggregation may be involved. Of many possible mechanisms to explain heightened aggregation, one that has been suggested is that mutations that eliminate charged amino acids could diminish repulsive forces that would inhibit aberrant protein:protein interactions. Mutations at twenty-one charged residues in SOD1 have been associated with fALS, but of the 11 Lys residues in the protein, only 1 has been identified as mutated in ALS patients. Here, we examined whether loss of positively charged surface Lys residues in SOD1 would induce misfolding and formation of intracellular inclusions. We mutated four different Lys residues (K30, K36, K75, K91) in SOD1 that are not particularly well conserved, and expressed these variants as fusion proteins with yellow fluorescent protein (YFP) to assess inclusion formation. We also assessed whether these mutations induced binding to a conformation-restricted SOD1 antibody, designated C4F6, which recognizes non-natively folded protein. Although we observed some mutations to cause enhanced C4F6 binding, we did not observe that mutations that reduce charge at these positions caused the protein to form intracellular inclusions. Our findings may have implications for the low frequency of mutations at Lys residues SOD1 in ALS patients.
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Affiliation(s)
- Keith Crosby
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, Florida, United States of America
| | - Anthony M. Crown
- College of Arts and Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Brittany L. Roberts
- College of Arts and Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Hilda Brown
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, Florida, United States of America
- SantaFe HealthCare Alzheimer’s Disease Research Center, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
| | - Jacob I. Ayers
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, Florida, United States of America
| | - David R. Borchelt
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, Florida, United States of America
- College of Arts and Sciences, University of Florida, Gainesville, Florida, United States of America
- SantaFe HealthCare Alzheimer’s Disease Research Center, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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Stage at which riluzole treatment prolongs survival in patients with amyotrophic lateral sclerosis: a retrospective analysis of data from a dose-ranging study. Lancet Neurol 2018. [PMID: 29525492 PMCID: PMC5899963 DOI: 10.1016/s1474-4422(18)30054-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Riluzole is the only drug to prolong survival for amyotrophic lateral sclerosis (ALS) and, at a dose of 100 mg, was associated with a 35% reduction in mortality in a clinical trial. A key question is whether the survival benefit occurs at an early stage of disease, late stage, or is spread throughout the course of the disease. To address this question, we used the King's clinical staging system to do a retrospective analysis of data from the original dose-ranging clinical trial of riluzole. Methods In the original dose-ranging trial, patients were enrolled between December, 1992, and November, 1993, in Belgium, France, Germany, Spain, Canada, the USA, and the UK if they had probable or definite ALS as defined by the El Escorial criteria. The censor date for the riluzole survival data was set as the original study end date of Dec 31, 1994. For this analysis, King's clinical ALS stage was estimated from the electronic case record data of the modified Norris scale, UK Medical Research Council score for muscle strength, El Escorial category, vital capacity, and gastrostomy insertion data. The lowest allocated stage was 2 because the original trial only included patients with probable or definite ALS. We used a χ2 test to assess the independence of stage at trial enrolment and treatment group, Kaplan-Meier product limit distribution to test the transition from each stage to subsequent stages, and Cox regression to confirm an effect of treatment group on time in stage, controlling for covariates. We did sensitivity analyses by combining treatment groups, using alternative strategies to stage, stratifying by stage at trial enrolment, and using multistate outcome analysis of treatments (MOAT). Findings We analysed the case records of all 959 participants from the original dose-ranging trial, 237 assigned to 50 mg/day riluzole, 236 to 100 mg/day, 244 to 200 mg/day, and 242 to daily placebo. Clinical stage at enrolment did not significantly differ between treatment groups (p=0·22). Time in stage 4 was longer for patients receiving 100 mg/day riluzole than for those receiving placebo (hazard ratio [HR] 0·55, 95% CI 0·36–0·83; log-rank p=0·037). Combining treatment groups and stratifying by stage at enrolment showed a similar result (HR 0·638, 95% CI 0·464–0·878; p=0·006), as did analysis with MOAT where the mean number of days spent in stage 4 was numerically higher for patients given riluzole at higher doses compared with patients receiving placebo. Time from stages 2 or 3 to subsequent stages or death did not differ between riluzole treatment groups and placebo (p=0·83 for stage 2 and 0·88 for stage 3). Interpretation We showed that riluzole prolongs survival in the last clinical stage of ALS; this finding needs to be confirmed in a prospective study, and treatment effects at stage 1 still need to be analysed. The ALS stage at which benefit occurs is important for counselling of patients before starting treatment. Staging should be used in future ALS clinical trials to assess the stage at which survival benefit occurs, and a similar approach could be used for other neurodegenerative diseases. Funding NIHR Maudsley Biomedical Research Centre, The European Union Joint Programme on Neurodegeneration, and the King's Summer Undergraduate Studentship.
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Riluzole and other prognostic factors in ALS: a population-based registry study in Italy. J Neurol 2018; 265:817-827. [PMID: 29404735 DOI: 10.1007/s00415-018-8778-y] [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] [Received: 09/15/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE In this prospective population-based registry study on ALS survival, we investigated the role of riluzole treatment, together with other clinical factors, on the prognosis in incident ALS cases in Emilia Romagna Region (ERR), Italy. METHODS A registry for ALS has been collecting all incident cases in ERR since 2009. Detailed clinical data from all patients diagnosed with ALS between 1.1.2009 and 31.12.2014 have been analyzed for this study, with last follow up date set at 31.12.2015. RESULTS During the 6 years of the study, there were 681 incident cases with a median tracheostomy-free survival of 40 months (95% CI 36-44) from onset and of 26 months (95% CI 24-30) from diagnosis; 573 patients (84.14%) were treated with riluzole, 207 (30.39%) patients underwent gastrostomy, 246 (36.12%) non invasive ventilation, and 103 (15.15%) invasive ventilation. Patients who took treatment for ≥ 75% of disease duration from diagnosis had a median survival of 29 months compared to 18 months in patients with < 75% treatment duration. In multivariable analysis, factors independently influencing survival were age at onset (HR 1.04, 95% CI 1.02-1.05, p < 0.001), dementia (HR 1.56, 95% CI 1.05-2.32, p = 0.027), degree of diagnostic certainty (HR 0.88, 95% CI 0.78-0.98, p = 0.021), gastrostomy (HR 1.46, 95% CI 1.14-1.88, p = 0.003), NIV (HR 1.43, 95% CI 1.12-1.82, p = 0.004), and weight loss at diagnosis (HR 1.05, 95% CI 1.03-1.07, p < 0.001), diagnostic delay (HR 0.98, 95% CI 0.97-0.99, p = 0.004), and % treatment duration (HR 0.98, 95% CI 0.98-0.99, p < 0.001). CONCLUSIONS Independently from other prognostic factors, patients who received riluzole for a longer period of time survived longer, but further population based studies are needed to verify if long-tem use of riluzole prolongs survival.
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Yang B, Shi X. Percutaneous endoscopic gastrostomy versus fluoroscopic gastrostomy in amyotrophic lateral sclerosis (ALS) sufferers with nutritional impairment: A meta-analysis of current studies. Oncotarget 2017; 8:102244-102253. [PMID: 29254240 PMCID: PMC5731950 DOI: 10.18632/oncotarget.22288] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022] Open
Abstract
Gastrostomy is recommended for Amyotrophic Lateral Sclerosis (ALS) patients with malnutrition. There are two main methods of gastrostomy insertion: Percutaneous Endoscopic Gastrostomy (PEG) and Fluoroscopic Gastrostomy (FG). The latter included Radiologically Inserted Gastrostomy (RIG) and Per-oral Image-Guided Gastrostomy (PRG). A meta-analysis was conducted to compare these approaches in terms of survival outcomes, pain occurrence and success rate, through the literature search in PubMed, Web of Science and Cochrane Library. A total of 7 studies with 701 cases (322 in PEG, 264 in RIG and 115 in PRG) were enrolled in the final analysis. The lack of differences between the comparisons (PEG vs. PRG, PEG vs. RIG and PEG vs. PRG+RIG) on 30-day mortality and survival length was confirmed. For the pooling analysis of peri- and post-procedural complications, patients with PEG had a lower incidence of pain than cases with PRG and RIG together (P < 0.001). The same trends could be found when compared with PRG and RIG, separately (P < 0.05 and P < 0.001, respectively). And PEG showed a lower rate of successful attempts than PEG and RIG (P < 0.05). For other complications, we didn't find any differences. This meta-analysis demonstrates that PEG, PRG and RIG had their intrinsic advantages. The current evidences could not determine the preference of them. Further investigations should be done to reveal the most appropriate method for ALS patients.
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Affiliation(s)
- Biying Yang
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China
| | - Xiaolei Shi
- Department of Neurology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, P.R. China.,Kinsmen Laboratory of Neurological Research, University of British Columbia, Vancouver, BC, Canada
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Martin S, Trevor-Jones E, Khan S, Shaw K, Marchment D, Kulka A, Ellis CE, Burman R, Turner MR, Carroll L, Mursaleen L, Leigh PN, Shaw CE, Pearce N, Stahl D, Al-Chalabi A. The benefit of evolving multidisciplinary care in ALS: a diagnostic cohort survival comparison. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:569-575. [PMID: 28719997 DOI: 10.1080/21678421.2017.1349151] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/05/2017] [Accepted: 06/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Care for people with amyotrophic lateral sclerosis (ALS) has altered at King's College Hospital over the last 20 years. The clinic has been a multidisciplinary, specialist, tertiary referral centre since 1995 with a large team with integrated palliative and respiratory care since 2006. We hypothesised that these changes would improve survival. METHODS In this retrospective observational study, patients diagnosed with El Escorial definite, probable and possible ALS between 1995-1998 and 2008-2011 were followed up. The primary outcome measure was a chi-square test for the proportion of each cohort surviving. Kaplan-Meier survival analysis and Cox multivariate regression were secondary analyses. RESULTS There was low reporting of some interventions. Five hundred and forty-seven people were included. Survival between the cohorts was significantly different (p = 0.022) with a higher proportion surviving during 2008-2011. Survival time was 21.6 (95% CI 19.2-24.0) months in the 2008-2011 cohort compared to 19.2 years (15.6-21.6) in the 1995-1998 cohort (log rank p = 0.018). Four hundred and ninety-three cases were included in the Cox regression. Diagnostic cohort was a significant predictor variable (HR 0.79 (0.64-0.97) p = 0.023). CONCLUSIONS These results support the hypothesis that integrated specialist clinics with multidisciplinary input improve survival in ALS.
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Affiliation(s)
- Sarah Martin
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Emma Trevor-Jones
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Sabyha Khan
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Keelan Shaw
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Deepti Marchment
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Anna Kulka
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Catherine E Ellis
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Rachel Burman
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Martin R Turner
- b Nuffield Department of Clinical Neurosciences , John Radcliffe Hospital , Oxford , UK
| | - Liam Carroll
- c Trafford Centre for Biomedical Research , Brighton and Sussex Medical School , Falmer , UK , and
| | - Leah Mursaleen
- c Trafford Centre for Biomedical Research , Brighton and Sussex Medical School , Falmer , UK , and
| | - P Nigel Leigh
- c Trafford Centre for Biomedical Research , Brighton and Sussex Medical School , Falmer , UK , and
| | - Christopher E Shaw
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Neil Pearce
- d Department of Medical Statistics, London School of Hygiene and Tropical Medicine , London , UK
| | - Daniel Stahl
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
| | - Ammar Al-Chalabi
- a Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK
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Goutman SA. Diagnosis and Clinical Management of Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders. Continuum (Minneap Minn) 2017; 23:1332-1359. [DOI: 10.1212/con.0000000000000535] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fang T, Jozsa F, Al-Chalabi A. Nonmotor Symptoms in Amyotrophic Lateral Sclerosis: A Systematic Review. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1409-1441. [PMID: 28805578 DOI: 10.1016/bs.irn.2017.04.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND ALS is a progressive neurodegenerative disease with no curative treatment. Nonmotor symptoms presenting in ALS may cause significant distress, worsen prognosis, and affect survival. OBJECTIVE To systematically review evidence for the prevalence of nonmotor ALS symptoms, and treatment options. METHODS Multiple medical literature databases were searched and studies screened using predefined inclusion criteria. Of 4580 studies, 44 were eligible for inclusion with 25 relating to treatment and 19 to the prevalence of nonmotor symptoms in ALS. RESULTS Nonmotor symptoms involve neuropsychiatric, autonomic, gastrointestinal, and vascular systems, and affect between 5% and 80% of people with ALS. Screening tools for individual nonmotor symptoms are useful in classifying symptom severity and to compare between treatment options. Several methods to relieve nonmotor symptoms have been trialed with varying success rates. CONCLUSIONS Many of the current studies of nonmotor symptoms in ALS have small sample sizes, requiring more evidence to increase precision in prevalence estimates. Further research is needed to assess the efficacy of current treatments and to find new therapies. Symptom relief or treatment of these nonmotor symptoms should therefore be considered during the clinical management of ALS.
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Affiliation(s)
- Ton Fang
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Felix Jozsa
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom.
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Al-Chalabi A, Hardiman O, Kiernan MC, Chiò A, Rix-Brooks B, van den Berg LH. Amyotrophic lateral sclerosis: moving towards a new classification system. Lancet Neurol 2017; 15:1182-94. [PMID: 27647646 DOI: 10.1016/s1474-4422(16)30199-5] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
Abstract
Amyotrophic lateral sclerosis is a progressive adult-onset neurodegenerative disease that primarily affects upper and lower motor neurons, but also frontotemporal and other regions of the brain. The extent to which each neuronal population is affected varies between individuals. The subsequent patterns of disease progression form the basis of diagnostic criteria and phenotypic classification systems, with considerable overlap in the clinical terms used. This overlap can lead to confusion between diagnosis and phenotype. Formal classification systems such as the El Escorial criteria and the International Classification of Diseases are systematic approaches but they omit features that are important in clinical management, such as rate of progression, genetic basis, or functional effect. Therefore, many neurologists use informal classification approaches that might not be systematic, and could include, for example, anatomical descriptions such as flail-arm syndrome. A new strategy is needed to combine the benefits of a systematic approach to classification with the rich and varied phenotypic descriptions used in clinical practice.
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Affiliation(s)
- Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK.
| | - Orla Hardiman
- Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Benjamin Rix-Brooks
- Carolinas Neuromuscular/ALS-MDA Center, Department of Neurology, Carolinas Medical Center, Carolinas Healthcare System Neurosciences Institute, Charlotte, NC, USA; University of North Carolina School of Medicine-Charlotte Campus, Charlotte, NC, USA
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Netherlands
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Hinchcliffe M, Smith A. Riluzole: real-world evidence supports significant extension of median survival times in patients with amyotrophic lateral sclerosis. Degener Neurol Neuromuscul Dis 2017; 7:61-70. [PMID: 30050378 PMCID: PMC6053101 DOI: 10.2147/dnnd.s135748] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the commonest form of motor neuron disease and is a fatal, degenerative, multisystem disorder affecting upper and/or lower motor neurons in the motor cortex, brain stem, and spinal cord. ALS is characterized by progressive atrophy of associated bulbar, limb, thoracic, and abdominal muscles and supporting cells manifesting in a range of muscular symptoms such as weakness and wasting and eventual paralysis; the majority of patients will die from respiratory failure within 2–5 years of onset. Riluzole, a synthetic benzothiazole drug with glutamine antagonist activity, is indicated for the treatment of patients with ALS and is the only drug that has been shown to slow the course of the disease and extend survival in ALS patients. The original analyses, and subsequent meta-analyses, of data obtained from randomized controlled trials (RCTs) suggest that riluzole typically extends survival by 2–3 months and increases the chance of an additional year of survival by ~9%. However, published real-world evidence (RWE) from 10 clinical ALS databases indicates that riluzole therapy may afford much greater extension of survival, and improvements in median survival times of more than 19 months have been reported in the overall ALS patient population. This article will review the available data from RCTs and RWE on riluzole therapy.
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Affiliation(s)
| | - Alan Smith
- PharmaSci Consulting Ltd, Nottingham, UK
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Abstract
Amyotrophic lateral sclerosis is a neurodegenerative disease predominantly affecting upper and lower motor neurons, resulting in progressive paralysis and death from respiratory failure within 2 to 3 years. The peak age of onset is 55 to 70 years, with a male predominance. The causes of amyotrophic lateral sclerosis are only partly known, but they include some environmental risk factors as well as several genes that have been identified as harbouring disease-associated variation. Here we review the nature, epidemiology, genetic associations, and environmental exposures associated with amyotrophic lateral sclerosis.
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Affiliation(s)
- Sarah Martin
- Maurice Wohl Clinical Neuroscience Institute, King’s College, London, UK
| | - Ahmad Al Khleifat
- Maurice Wohl Clinical Neuroscience Institute, King’s College, London, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King’s College, London, UK
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Fang T, Al Khleifat A, Stahl DR, Lazo La Torre C, Murphy C, Young C, Shaw PJ, Leigh PN, Al-Chalabi A. Comparison of the King's and MiToS staging systems for ALS. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:227-232. [PMID: 28054828 PMCID: PMC5425622 DOI: 10.1080/21678421.2016.1265565] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: To investigate and compare two ALS staging systems, King’s clinical staging and Milano-Torino (MiToS) functional staging, using data from the LiCALS phase III clinical trial (EudraCT 2008-006891-31). Methods: Disease stage was derived retrospectively for each system from the ALS Functional Rating Scale-Revised subscores using standard methods. The two staging methods were then compared for timing of stages using box plots, correspondence using chi-square tests, agreement using a linearly weighted kappa coefficient and concordance using Spearman’s rank correlation. Results: For both systems, progressively higher stages occurred at progressively later proportions of the disease course, but the distribution differed between the two methods. King’s stage 3 corresponded to MiToS stage 1 most frequently, with earlier King’s stages 1 and 2 largely corresponding to MiToS stage 0 or 1. The Spearman correlation was 0.54. There was fair agreement between the two systems with kappa coefficient of 0.21. Conclusion: The distribution of timings shows that the two systems are complementary, with King’s staging showing greatest resolution in early to mid-disease corresponding to clinical or disease burden, and MiToS staging having higher resolution for late disease, corresponding to functional involvement. We therefore propose using both staging systems when describing ALS.
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Affiliation(s)
- Ton Fang
- a Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience , King's College London , UK
| | - Ahmad Al Khleifat
- a Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience , King's College London , UK
| | - Daniel R Stahl
- b Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience , King's College London , UK
| | | | - Caroline Murphy
- b Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience , King's College London , UK
| | | | - Carolyn Young
- d The Walton Centre NHS Foundation Trust , Liverpool , England
| | - Pamela J Shaw
- e Department of Neuroscience , University of Sheffield , England , and
| | - P Nigel Leigh
- f Department of Neurology , Brighton and Sussex Medical School , England
| | - Ammar Al-Chalabi
- a Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience , King's College London , UK
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Spiller KJ, Restrepo CR, Khan T, Stieber AM, Kwong LK, Trojanowski JQ, Lee VMY. Progression of motor neuron disease is accelerated and the ability to recover is compromised with advanced age in rNLS8 mice. Acta Neuropathol Commun 2016; 4:105. [PMID: 27687289 PMCID: PMC5043606 DOI: 10.1186/s40478-016-0377-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 12/14/2022] Open
Abstract
In order to treat progressive paralysis in ALS patients, it is critical to develop a mouse that closely models human ALS in both pathology and also in the timing of these events. We have recently generated new TDP-43 bigenic mice (called rNLS8) with doxycycline (Dox)-suppressible expression of human TDP-43 (hTDP-43) harboring a defective nuclear localization signal (hTDP-43∆NLS) under the control of the NEFH promoter. Our previous studies characterized the pathology and disease course in young rNLS8 mice following induction of neuronal hTDP-43ΔNLS. We now seek to examine if the order and timing of pathologic events are changed in aged mice. We found that the expression of hTDP-43∆NLS in 12+ month old mice did not accelerate the appearance of neuromuscular abnormalities or motor neuron (MN) death in the lumbar spinal cord (SC), though disease progression was accelerated. However, following suppression of the transgene, important differences between young and aged rNLS8 mice emerged in functional motor recovery. We found that recovery was incomplete in aged mice relative to their younger treatment matched counterparts based on gross behavioral measures and physiological recordings from the animals’ gastrocnemius (GC) muscles, despite muscle reinnervation by surviving MNs. This is likely because the reinnervation most often only resulted in partial nerve and endplate connections and the muscle’s junctional folds were much more disorganized in aged rNLS8 mice. We believe that these studies will be an important basis for the future design and evaluation of therapies designed to slow denervation and promote re-innervation in adult ALS patients.
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